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NERVOUS  AND  MENTAL  DISEASE  MONOGRAPH  SERIES  No.  24 


STUDY  OF  ORGAN  INFERIORITY  AND 
ITS  PSYCHICAL  COMPENSATION 

A  CONTRIBUTION  TO  CLINICAL  MEDICINE 


BY 

DR.  ALFRED  ADLER 

OF   VIENNA 


AUTHORIZED   TRANSLATION   BY 

SMITH  ELY  JELLIFFE,  M.D. 


NEW  YORK 

THE  NERVOUS  AND  MENTAL  DISEASE 

PUBLISHING  COMPANY 

1917 


NERVOUS   AND  MENTAL   DISEASE 
MONOGRAPH   SERIES 

Edited  by 

Drs.  SMITH  ELY  JELLIFFE  and  WM.  A.  WHITE 
Numbers  Issued 

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New  York  Psychiatrical  Society . 

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PREFACE 

The  purpose  of  this  book  is  to  add  to  clinical  rppHirin/*  a 
principle  of  research.  From  the  completeness  and  the  import  of 
these  early  results  I  am  sure  that  I  have  come  upon  very  fruitful 
territory. 

To  me,  moreover,  it  was  an  attractive  task  to  see  our  benumbered 
and  thwarted  conceptions  of  disease  completely  dissolved ;  to  be  able 
to  observe  human  pathology  in  its  making. 

Many  a  valuable  bit  of  knowledge  has  supported  my  theory  of 
the  inferiority  of  organs.  I  have  been  unable  to  give  acknowledg- 
ment to  all  at  the  proper  place,  as  I  should  have  liked.  In  this  paper, 
in  addition  to  the  authors  named,  the  range  of  thought  of  Martins, 
Rosenbach,  Exner,  Bering,  Obersteiner,  Haeckel,  Schwalbe,  and 
many  another  has  played  a  large  part. 

This  work  is  to  count  as  a  beginning.  Perhaps,  at  some  future 
time,  I  shall  be  permitted  to  make  the  connection  with  clinical  medi- 
cine, with  psychology,  and  pedagogy  still  closer  by  bringing  together 
all  previous  works  on  the  subject.1 

1  The  author  has  advanced  this  purpose  in  his  monograph  on  the  "  Nerv- 
ous Character,"  a  translation  of  which  has  been  published  by  Drs.  Glueck 
and  Lind. 


CONTENTS 

PACK 

INTRODUCTION   vii 

CHAP.        I.  OUTLINE  OF  THEORY  ON  ORGANIC  INFERIORITY.  . .     i 

CHAP.      II.  HEREDITY    12 

CHAP.    III.  ANAMNESTIC  DEMONSTRATION  21 

CHAP.     IV.  MORPHOLOGIC  INDICATIONS  25 

CHAP.  V.  REFLEX  ANOMALIES  AS  INDICATIONS  OF  INFERIOR- 
ITY    38 

CHAP.     VI.  MANIFOLD  ORGANIC  INFERIORITIES  50 

CHAP.  VII.  THE  PART  PLAYED  BY  THE  CENTRAL  NERVOUS  SYS- 
TEM IN  THE  THEORY  OF  ORGANIC  INFERIORITY — 
PSYCHOGENESIS  AND  FOUNDATIONS  OF  NEUROSES, 

AND  PSYCHONEUROSES  56 

CHAP.  VIII.  BIOLOGIC  POINT  OF  VIEW  IN  THE  THEORY  OF  OR- 
GANIC INFERIORITY  67 

APPENDIX:  THE  INFERIORITY  OF  THE  URINARY  APPARATUS. — 
FATE  OF  ENURETICS  AND  THEIR  DESCENDANTS 70 

INDEX    87 


INTRODUCTION 

An  examination  of  the  diseases  of  the  urinary  apparatus  can  be 
very  extensively  carried  on  so  far  as  their  symptomatology  is  con- 
cerned. In  renal  pathology,  as  in  all  other  diseases,  the  schema  of 
symptoms  is  built  up  empirically,  and  accordingly  rests  on  a  firm  basis. 
It  is  richly  enough  equipped  to  lead  the  diagnostics  of  renal  dis- 
eases along  safe  paths.  The  compass  is  at  once  reduced,  however, 
when  the  examination  is  directed  towards  etiology.  The  theories  of 
the  causes  of  renal  diseases  read  like  a  short  collection  of  truisms, 
in  which  terms  such  as  predisposition,  chill,  poisons,  infection,  dis- 
turbance of  the  circulation  appear  and  reappear  and  play  their  part, 
just  as  they  do  in  other  organic  diseases. 

The  fact  that  a  definition  of  these  causal  factors  themselves  Is 
notably  lacking  ought  not  even  to  be  particularly  emphasized. 
More  important  is  the  fact  that  there  is  so  little  positive  material 
available  to  decide  the  question  concerning  the  localization  of  disease 
in  the  kidney.  What  has  been  emphasized,  the  sickening  of  the  kidneys 
through  poisoning  or  infection  as  well  as  through  the  progressive 
changes  in  affections  of  the  circulatory  system,  all  this  is  in  line  with 
the  basal  concepts  of  pathology,  for  the  urinary  organs  are  affected 
like  all  others  proportionately  to  their  relation  to  the  disease  centres. 

The  conditions  in  those  cases  which  one  is  forced  to  designate 
as  "genuine,"  or  "primary"  diseases  of  the  kidney  are  less  clear. 
A  long  list  of  diseases  falls  under  these  heads.  They  all  have 
this  in  common,  namely,  that  the  final  cause  of  their  pathologic 
form  cannot  be  traced  beyond  the  kidney,  and  that  a  more  remote 
or  even  an  exogenous  etiology — from  the  very  name — seems  out 
of  the  question.  Here  may  be  reckoned,  if  all  other  distinguish- 
ing indications  are  put  aside,  true  contracted  kidney,  renal  tumors, 
localized  lues  and  tuberculosis,  cystic  degeneration,  nephrolithiasis, 
nephralgie  hematurique,  renal  hematuria,  floating  kidney,  imper- 
fect development  and  hypoplasia  and  analogous  diseases  in  the 
pelvis  of  the  kidney  and  ureter.  I  must  add  also  that  the  genetic 
course  of  development  in  secondary  diseases  must  not  under  any 
consideration  be  deemed  exhausted  by  reference  to  the  causa 
movens,  but,  rather,  in  these  cases  too,  the  selection  of  the  kidney 
is  determined  in  a  hitherto  unexplained  manner. 

If  one  turns  aside  from  an  explanatory  attempt  which  limits 


Viii  INTRODUCTION 

itself  to  causes  of  disease  which  are  purely  local  and  situated  in  the 
kidney,  one  can  divide  the  notions  on  localization  of  disease  in  the 
kidney  synoptically  into  three  groups,  of  which  each  one  has  ref- 
erence to  secondary  as  well  as  primary  diseases.  The  one  hypoth- 
esis tries  to  make  the  selection  of  the  kidney  as  center  of  the  disease 
tenable  on  the  ground  of  "  nephrotoxic "  action  of  a  number  of 
poisons.  The  strength  of  this  hypothesis  lies  in  experimentation, 
as  well  as  in  a  number  of  recorded  cases  which  bring  to  mind  a 
noxa  especially  harmful  to  the  kidney,  such  as  is  present  in  scarlet 
fever,  diphtheria  and  other  infections.  On  the  other  hand  it  is  in- 
applicable to  a  great  number  of  renal  affections,  does  not  offer  an 
explanation  for  the  kidney's  remaining  unaffected  upon  the  appear- 
ance of  renal  poisons,  and  should  only  be  generalized  with  the  utmost 
caution  on  the  basis  of  animal  experimentation.  At  any  rate  we 
know  of  no  poison  at  present  that  invariably  harms  the  kidneys, 
and  at  the  same  time,  only  the  kidneys.  A  second  conception  sees 
the  cause  of  the  greater  number  of  renal  diseases  in  the  exposed 
position  of  the  kidney  as  an  organ  of  excretion  through  which  the 
waste  material  of  the  body  is  constantly  passing.  This  hypothesis 
is  supposed  to  serve  as  a  sufficient  explanation  for  most  of  the  renal 
affections.  Its  application  is  surely  greater  and  its  bearing  unques- 
tionable, since  it  has  to  do,  not  only  with  true  toxins,  but  also  with 
the  increase  of  waste  products  and  with  heightened  external  de- 
mands upon  the  kidney.  But  even  with  this  conception  we  are  not 
in  a  position  to  give  satisfactory  explanations.  It  also  leaves  us  in 
the  lurch  when  we  ask  why,  with  the  admission  of  the  premises, 
that  is,  the  presence  of  bacteria  in  the  blood,  of  toxins  and  poisons, 
of  chronic  metabolic  anomalies,  of  alcoholism,  pregnancy  or  chill, 
the  kidneys  are  so  often  found  healthy.  It  also  fails  us  in  at- 
tempting to  explain  one-sided  disease  of  the  kidneys,  as  in  cases  of 
tuberculosis,  lues,  and  tumors.  These  and  other  inadequacies  force 
us  to  a  third  view,  which  will  be  championed,  and  with  good  cause, 
I  believe,  in  this  book,  a  conception  according  to  which  most  renal 
diseases  are  caused  by  a  fundamental  inferiority  of  the  urine-ex- 
creting apparatus. 

That  such  a  condition  may  be  accepted  for  many  cases,  and  plays 
its  part  in  renal  pathology  is  probably  universally  recognized.  The 
appearance  of  true  renal  diseases  can  not  be  sufficiently  explained 
by  the  acceptance  of  hypothetical  poisons  of  metabolism.  Above 
all,  the  pathological  findings,  as  well  as  the  clinical  course,  both  con- 
tradict chronic  poisoning.  This  view  is  refuted  almost  as  strongly 
by  the  frequently  long  duration  and  by  the  numerous  hereditary  ap- 


INTRODUCTION  ix 

pearances.  In  the  same  way,  albuminuria  of  puberty,  renal  hemo- 
philia, cystic  kidney,  the  pregnancy  kidney,  orthostatic  albuminuria, 
and  albuminuria  connected  with  constipation  are  all  indications, 
which  one  can  hardly  overlook.  But  one  of  the  strongest  argu- 
ments for  inferiority  of  the  urine-excreting  apparatus  as  the  cause 
of  renal  diseases,  is  heredity,  which  is  so  often  found  in  renal  pathol- 
ogy. At  most  it  is  still  questionable  whether  certain  of  these  cases 
of  albuminuria  should  be  considered  diseases.  The  difficulties  in 
determining  this  question  will  not  be  denied,  for  the  transition 
from  mild  anomalies  in  the  condition  of  the  urine,  to  severe  forms 
of  renal  diseases,  has  not  yet  been  sufficiently  studied.  But  even  ces- 
sation for  a  number  of  years  or  improvement  of  the  phenomena, 
whether  under  medical  treatment  or  not,  has  no  conclusive  force. 
One  can,  however,  justly  emphasize  that  the  acceptance  of  inferi- 
ority of  the  kidney  as  the  cause  of  renal  diseases,  regarded  from  the 
pathological  viewpoint,  has  many  probabilities  in  its  favor,  that  the 
transition  from  abnormal  development  and  functional  anomalies  to 
disease  can  be  brought  about  in  the  shortest  time,  and  that  in  many 
cases  it  becomes  questionable  just  where  the  aspect  of  the  disease 
begins  for  us.  The  "physiological"  albuminurias  play  the  same 
part  there  as,  say,  the  cystic  kidney,  which  can  formally  appear 
overnight  as  a  severe  illness,  after  it  has  existed  for  some  time  with- 
out any  symptoms. 

By  means  of  an  examination  of  this  sort,  from  the  standpoint 
of  an  inferiority  theory,  these  previously  mentioned  affections  of 
the  urinary  apparatus  attain  their  proper  place  in  pathology  for  the 
first  time.  Their  significance  in  the  field  of  renal  pathology  comes 
out  more  clearly  through  the  demonstration  of  a  fundamental  in- 
feriority. At  the  same  time  it  seems  necessary  to  conduct  more 
searchingly  the  examination  of  constitutional  organic  anomalies  as 
the  foundation  of  many,  perhaps  of  most  diseases,  so  that  the  diag- 
nostician may  draw  strong  support  from  the  facts  of  the  inferiority 
theory.  The  value  of  this  view,  however,  extends  to  the  study  of 
the  symptoms  also,  and  to  experimental  pathology.  In  regard  to 
the  latter,  it  determines  once  for  all  the  differences  between  inferior 
and  normal  organs  and  thus  interferes  with  the  unlimited  trans- 
ference of  results  of  animal  experimentation  to  human  beings,  and 
of  experiences  with  well  people  to  sick  ones.  In  regard  to  the 
first,  it  seeks  to  establish  a  still  closer  bond  between  the  empirically 
determined  symptoms,  and  the  diseased  organ,  and  makes  related 
organs  responsible  for  symptoms  of  a  more  widespread  organic 
disease.  There  will  be  particular  stress  laid  on  personal  prophy- 


X  INTRODUCTION 

laxis  in  all  those  cases  where  it  is  possible  to  deduce  organic  in- 
feriority, where  signs  of  disease  have  not  been  already  proved. 
Just  as  is  the  case  at  present,  when  diseases  in  the  parents  arouse 
suspicions  in  regard  to  the  children.  We  must  determine  first  of  all 
for  therapy  whether  the  inferior  organ  should  be  and  can  be,  by 
means  of  any  sort  of  a  course  of  treatment,  aroused  to  sufficient 
function  and  eventually  to  additional  development,  a  question  to 
which  one  can  often  answer  yes,  in  the  case  of  young  people,  but 
which  with  older  patients  must  frequently  be  answered  by  no.  The 
answering  of  this  question  will,  however,  usually  call  for  a  deeper 
knowledge  of  the  nature  of  the  inferiority  in  question,  and  its  sig- 
nificance for  the  patient  concerned.  If  one  is  obliged  to  give  up 
an  active  cure,  or  training,  then  the  laws  of  a  protective  plan 
of  treatment — rest,  relief — come  to  the  fore.  Finally,  in  making  the 
prognosis,  quoad  vitam,  or  sanationem,  the  inferiority  theory,  like- 
wise, guarantees  valuable  aid.  From  the  point  of  view  now  resorted 
to,  not  only  the  sum  of  the  phenomena  presenting  themselves,  the 
phases,  so  to  speak,  of  the  contest,  will  have  to  be  taken  into  con- 
sideration, but  the  valuation  of  the  organ  has  also  to  be  effected, 
and  we  must  fix  our  eyes  upon  the  relation  of  this  value  to  the  dis- 
ease-exciting force. 

These  explanations  will  serve  to  substantiate  the  fact  that  a 
study  of  the  inferiority  of  organs  is  at  the  foundation  of  some  of 
the  most  important  problems  of  pathology.  In  the  following  pages 
I  shall  try  to  establish  that  this  theory  may  claim  to  be  considered 
as  a  valuable  "  heuristic  "  method  on  the  basis  of  the  characters  or 
conditions  that  underlie  it. 


STUDY  OF  ORGAN  INFERIORITY  AND  ITS 
PSYCHICAL  COMPENSATION 


CHAPTER  I 
OUTLINE  OF  A  THEORY  OF  ORGAN   INFERIORITY 

After  having  attempted  in  the  previous  pages  to  sketch  the 
great  significance  of  a  study  of  organ  inferiority  in  renal  pathology, 
to  which  we  will  add  a  few  special  additional  illustrations  in  the 
supplement,  we  find  ourselves  called  upon  to  enlarge  the  domain  of 
our  research  and  to  take  into  consideration  all  of  the  organs.  We 
must  do  this  so  much  the  more,  as,  on  the  one  hand,  the  argument 
which  gave  us  the  authority  for  declaring  the  inferiority  of  the 
urine-secreting  apparatus  one  of  the  fundamentals  of  renal  pathol- 
ogy, can  be  made  to  apply  to  all  other  organic  diseases,  and  on  the 
other  hand,  the  pathological  phenomena  of  the  diseased  kidney  can, 
in  an  analogous  manner,  be  demonstrated  in  the  whole  field  of  pathol- 
ogy. Chronic  transformation  of  the  parenchyma,  pathological  form  of 
the  supporting  tissue,  cystic  degeneration,  formation  of  concretions, 
localization  of  inflammatory  and  neoplastic  tumors,  malformation, 
imperfect  development,  diminished  development  in  the  whole  ap- 
paratus or  in  parts  of  it  recur  in  all  or  several  of  the  organic 
diseases,  and  the  theory  of  inferiority  always  seems  called  upon  to 
complete  the  otherwise  insufficient  etiology. 

We  find  analogous  transformations  in  the  liver,  in  the  pancreas, 
in  the  thyroid  gland,  in  the  genital  tract,  in  parts  of  the  digestive 
tract,  the  respiratory  and  circulatory  systems,  and  in  the  central 
nervous  system.  A  great  number  of  these  diseases  are  marked  by 
characteristics  which  are  emphasized  in  renal  diseases,  such  as  hered- 
ity, chronic  course  of  the  disease,  typical  localization  within  the 
organ,  an  insufficient  etiology  supported  neither  by  poisons  nor  bac- 
teria, but  they  can  easily  be  put  into  a  framework  of  a  theory  of 
inferiority.  This  is  the  case  in  the  pathology  of  the  thyroid  gland, 
the  etiology  of  which  has  proved  itself  quite  insufficient,  but  which 
corresponds  to  all  the  heretofore  mentioned  conditions  of  an  in- 
feriority theory,  particularly  that  of  heredity.  The  macroscopic  as 
well  as  the  microscopic  pathological  changes  of  the  liver  show  phe- 


2  STUDY   OF   ORGAN    INFERIORITY 

nomena  analogous  to  those  seen  in  almost  every  case  of  renal  dis- 
ease, for  which  reason  the  primary  diseases  naturally  interest  us 
most. 

It  seems  superfluous  to  us,  further,  to  point  out  in  detail  how 
certain  transformations  may  be  found  in  every  individual  organ, 
since  this  is  really  a  problem  clearly  enough  set  forth  in  general 
pathology.  Only  the  lack  of  satisfactory  etiology  will  be  empha- 
sized in  this  connection.  On  the  other  hand,  the  question  which  is 
raised  in  this  paper,  and  which  we  are  trying  to  solve,  asks  rather, 
what  reasons  there  are  for  the  fact  that  certain  diseases  attack  just 
a  certain  organ.  The  solution  accepted  by  us,  which  takes  a  primary 
inferiority  of  this  organ  as  a  basis  of  the  disease,  is  at  one  with  the 
opinions  and  researches  of  many  authors.  In  this  question  we  can, 
perchance,  only  claim  to  have  undertaken  the  study  of  organ  inferior- 
ity more  comprehensively,  and  to  have  considered  its  significance  of 
greater  import.  A  greater  objection  might  however  be  raised  against 
the  further  declaration  that  other  diseases,  too,  not  considered  true 
diseases,  such  as  infectious  diseases,  and  "  adventitious "  diseases, 
often  require,  or  at  least  are  dependent  upon  the  assumption  of  or- 
gan inferiority  in  their  course.  A  still  greater  number  of  diseases 
might  be  mentioned  at  this  point,  as,  for  instance,  tuberculosis, 
which  is  probably  always  localized  in  the  inferior  organ,  an  assump- 
tion which,  if  conclusively  established  would  bring  many  of  the 
doubtful  questions  relating  to  heredity,  place  of  entry,  and  paths  of 
infection,  immunity  and  therapy,  nearer  to  a  solution.  The  colon- 
ization of  Loffler's  bacillus  and  other  microorganisms  in  the  pharyn- 
geal  space,  of  the  Frankl-Weichselbaum  diplococci  in  the  lungs,  the 
agents  of  typhoid,  cholera  and  dysentery  at  definite  spots  in  the 
intestine,  and  many  other  infections,  likewise,  fall  under  this  head. 
At  the  same  time  the  part  that  bacterial  invasion  has  played  should 
not  be  denied.  But  the  acceptance  of  an  inferiority  of  the  diseased 
organs  seems  particularly  assured,  since  the  presence  of  many  patho- 
genic microorganisms  can  be  demonstrated  in  well  people.  To  be 
sure,  one  can  often  expect  only  obscure  signs  of  inferiority,  in  fact 
in  a  number  of  these  diseases  the  illness  itself  and  its  course  must 
be  considered,  for  the  time  being,  as  evidence  of  inferiority.  This 
causes  us  to  drop  the  conception  of  "  absolute  "  inferiority  for  these 
widely  spread  diseases,  and  to  introduce  the  term  "relative"  in- 
feriority, which  is  of  value,  be  it  temporarily  or  only  in  regard  to 
certain  causes  of  disease.  As  regards  tuberculosis,  to  be  sure,  the 
proofs  of  primary  inferiority  of  the  lung,  or  of  other  attacked 
organs,  seem  to  be  abundantly  present.  The  very  appearance  of 


AND   ITS    PSYCHICAL    COMPENSATION  -      3 

heredity  makes  this  more  easily  acceptable.  Likewise  the  frequently 
typical  localization  in  the  lungs,  kidneys,  joints  and  brain.  As  a 
matter  of  fact,  citations  may  be  quoted  which  give  information  in 
regard  to  certain  arrests  of  development,  as  those  of  Frankl,  Schick 
and  Sorgo,  statements  which  we  can  without  further  ado  classify 
with  the  signs  of  degeneration  which  are  emphasized  later  on. 

With  reference  to  diabetes,  epilepsy,  tumors,  chronic  alcoholism, 
obesity,  cretinism,  and  a  few  other  diseases,  I  undertake  to  deter- 
mine, after  looking  through  a  considerable  amount  of  material,  their 
position  with  reference  to  the  study  of  organ  inferiority.  A  little 
series  of  observations  has  suggested  to  me  to  consider  these  diseases,  ^ 
also,  as  built  upon  a  foundation  of  organ  inferiority. 

The  role  of  chance  in  diseases  of  inferior  organs  is  surely  not  as 
great  as  is  commonly  thought.  One  comes  in  contact,  at  least,  with 
cases  that  strike  one  so  remarkably  that  a  greater  number  of  them 
succeed  in  convincing  one  that  their  determination  has  been  differ- 
erently  and  more  strictly  given  than  by  mere  chance.  One  of  these 
cases  I  will  present  in  the  following.  Ladislaus  F.,  8  years  old, 
was  injured  in  August  of  the  year  1905,  by  a  pen  which  went  into 
the  outer  upper  quadrant  of  the  lejfteyeball,  and  reached  through 
the  conjuctiva  bulbi  into  the  sclera.  The  patient  had  come  too  close 
to  a  schoolmate  who  was  brandishing  a  pen,  yet  neither  of  the  boys 
could  be  accused  of  malevolence  or  particular  inattention.  The 
wound  healed  with  slight  reactions.  In  October  of  the  year  1905, 
the  boy  again  presented  himself  with  a  coal-splinter,  which  a  gust 
of  wind  had  blown  into  his  eye,  imbedded  in  the  cornea  of  his  left 
eye.  After  extracting  the  foreign  body  the  wound  soon  healed. 
In  January,  1906,  the  patient  again  received  a  prick  in  the  left  eye, 
which  was  caused,  just  as  on  the  first  occasion,  by  a  schoolmate 
with  a  pen  he  was  using,  and  which  was  about  I  cm.  below  and  inside 
the  first  punctured  wound.  This  wound  also  healed  like  the  first,  in  a 
short  time,  leaving  an  ink-tinged  scar.  One  might  think  that  all  this 
was  purely  bad  luck.  I  was  able  to  ascertain  the  following:  The 
maternal  grandfather  suffered  from  dia.bp.fir  iriHs  and  was  for  a 
long  time  under  the  care  of  an  oculist.  The  mother  had  convergent 
strabismus,  likewise  the  patient's  younger  brother,  and  both  had 
hypermetropia  and  diminished  acuteness  of  vision,  which  could  not 
be  accurately  demonstrated  owing  to  the  inattention  and  lack  of  in- 
telligence of  the  boy.  One  of  the  mother's  brothers  was  troubled 
by  numerous  recurrences  of  conjunctival  eczema,  and  had  con- 
vergent strabismus.  Our  patient  had  full  acuteness  of  vision, 
hypermetropia  to  a  slight  degree,  but  showed  a  lack  of  the  conjunc- 
tival reflex  in  both  eyes. 


4  STUDY   OF  ORGAN    INFERIORITY 

^"     t 

I  do  not  wish  to  deduce  too  much  from  this  case.  Neverthe- 
less it  seems  certain  to  me  that  one  must  accept  an  inferiority  of 
the  organ  of  vision  in  this  boy,  which  is  pretty  well  established  by 
heredity,  the  different  varieties  of  illness  in  his  relatives,  partly  of 
inflammatory,  partly  of  functional  nature,  and  the  deficiency  of  the 
reflex  function  of  the  conjunctiva  and  the  poor  protection  of  the| 
eyes,  a  fact  which  seems  to  me  to  be  related  in  some  not  yet  wholly 
explained  way  to  the  deficient  reflex  action.  At  this  point  I  must 
also  add  that  under  adequate  psychical  conditions,  by  means  of 
greater  activity  on  the  part  of  the  psyche,  the  above  mentioned  in- 
feriority of  the  eyes  may  be  made  good.  The  boy  can  learn  by 
experience  and  can  hide  the  partly  organic  defect  by  psychical  ex- 
ertion.  The  transition  between  nrganir  inferiority  a'nd  osvdalcal 
compensation  becomes^OWiipTylitiiibitJle  in  such  cases.  But  there 
can  also  be  no  question  that  from  the  nature  of  the  psychical  com- 
pensation the  traces  of  the  redeemed  organic  inferiority  remain 
unobliterated,  and  that,  for  example,  in  the  above-mentioned  case, 
the  protection  of  the  eyes  must  have  moved  into  the  field  of  con- 
scious awareness,  and  in  this  manner  the  visual  character  of  the 
individual  experienced  a  particular  strengthening.  But  more  of 
this  later. 

Meanwhile  permit  me  to  add,  in  this  connection,  the  following 
about  the  nature  of  organ  inferiority,  which  seems  already  to  have 
been  elucidated  here  and  there :  For  the  purpose  of  a  simple  and  dis- 
tinct arrangement,  we  shall  name  only  two  forms  in  which  the  in- 
feriority of  an  organ  expresses  itself,  morphologic  and  functional 
inferiority.  Both  are  present  at  the  same  time  in  the  majority  of 
cases.  I  should  like  to  designate  as  "relative"  inferiority,  a  third 
form,  upon  which  I  shall  lay  little  stress.  This  declares  itself  only 
in  the  case  of  illness  and  becomes  recognizable  only  under  increased 
demands  or  following  upon  systematic  tests. 

i.  Morphologic  Inferiority:  One  can  point  out  as  deficient  the 
development  of  the  shape  of  an  organ,  its  size,  its  individual  por- 
tions of  tissue,  individual  cell  complexes,  of  the  whole  apparatus 
or  of  limited  parts  of  the  same.  A  certain  probability,  which  is  in 
accord  with  biological  conditions,  would  have  it  appear  that  funda- 
mentally just  the  most  highly  developed,  differentiated  cells  and  cell- 
complexes  have  come  out  the  worst,  while  the  tissues  of  lesser 
capacity,  which  owe  their  development  to  an  earlier  embryologic 
epoch,  may  be  normally  or  even  super-normally  developed.  The  de- 
ficiency will  concern  first  of  all  those  portions  of  tissue  which  as 
secretory,  nervous  elements,  protective  tissue,  excretory  ducts  or 


AND   ITS    PSYCHICAL    COMPENSATION  _     5 

supply  channels,  guarantee  the  full  development  of  the  function. 
When  life  activity  begins  and  with  it  the  innumerable  sources  of 
stimulus  of  energy  and  metabolism,  the  remaining  fetal  or  postem- 
bryonic  tissues  will  experience  a  great  demand  and  a  sufficient  sud- 
den impulse  to  growth.  Their  final  formation  will,  to  be  sure,  not 
be  that  of  normal  fetal  development,  but  will  be  enough  to  insure 
the  functions  necessary  to  life.  In  relation  to  the  life  and  health  of 
the  individual,  the  consideration  is,  that  one  of  his  organs  has  to 
perform  the  functions  necessary  to  the  economy  of  the  organism 
with  a  lesser  stock  of  tissues  or  one  less  capable  of  resistance. 
With  satisfactory  structural  material  and  sufficient  provisions  it 
is  often  possible  to  master  the  work.  But  just  as  often,  perhaps, 
the  hour  comes  when  the  insufficiency  of  the  organ  is  revealed, 
when  the  external  and  internal  hindrances  can  no  longer  be  con- 
trolled. The  normal  structure  and  wear  and  tear  of  the  organ 
give  place  to  regressive  phenomena,  which  are  just  as  much  deter- 
mined in  their  nature  by  the  morphologic  inferiority  of  the  organ, 
as  by  the  special  causes  setting  the  disease  in  action.  The  moment 
at  which  the  function  necessary  to  life  fails  is  relative.  It  is  accord- 
ingly not  at  all  surprising  to  find  that  at  times  inferior  organs  suffice 
for  a  complete  lifetime. 

From  the  conditions  of  morphologic  inferiority  of  an  organ  the 
cause  of  which  is  always  fetal  defect  of  development,  the  following 
conclusions  may  be  positively  drawn : 

1.  Since  the  fetal  defect  in  development  is  brought  about  by  in- 
herited or  acquired  properties  of  the  spermatozoon  or  ovum  the 
hereditary  character  of  organ  inferiority  must  stand  out  in  a  par- 
ticular fashion.    The  heredity  may  not  always  be  exhausted  in  the 
morphologic  inferiority  of  one  and  the  same  organ,  it  can,  as  will  be 
later  shown,  be  proved  by  functional  deficiency,  by  inferiority  of  a 
second  organ,  as  was  pointed  out  before,  or  by  cases  of  illness 
["  relative  "  inferiority]  among  relatives. 

2.  Since  the  greater  number  of  organs  are  withdrawn  from  direct 
observation  we  are  often  compelled  to  infer  possible  inferiorities 
from  anomalies  in  their  size,  form,  and  position.     An  extremely  im- 
portant makeshift  is  presented  in  the  functional  anomalies  which 
should  be  considered  in  conjunction  with  other  characteristics  of 
organ  inferiority  as  authorized  signs  of  inferiority.     Directly  per- 
ceivable to  the  eye  and  sense  of  touch  are  the  organic  inferiorities 
lying  close  to  the  outer  integument  and  often  standing  in  relation 
to  it.     These  have  passed  up  to  the  present  day  under  the  name  of 
external  signs  of  degeneration,  or  stigmata.     They  represent  for 


6     ,  STUDY   OF   ORGAN    INFERIORITY 

the  greater  part  nothing  more  than  the  visible  expression  of  the  in- 
feriority of  the  related  organ,  whereupon  in  the  individual  cases,  at 
all  events,  the  question  always  arises  as  to  how  far  into  the  deeper 
part  of  the  organ  the  inferiority  extends. 

3.  From  the  fetal  character  of  the  morphologic  organ  inferi- 
ority, from  the  embryonic  lack  of  material  which  we  think  causes 
this,  it  follows  that  frequently  manifold  organ  inferiority  must  occur 
which  can  be  explained  either  by  local  difficulties  or  by  deficiency 
of  material  extending  through  several  organs.  The  relation  of 
different  organs  to  each  other  has  to  play  a  part  in  this,  a  part  which 
began  likewise  in  the  embryonic  stage.  In  these  cases  also,  a  fact 
which  is  confirmed  by  experience,  a  morphologic  anomaly  can 
be  replaced  by  a  functional  defect. 

2.  Functional  Inferiority.  Perhaps  this  is  the  chief  group, 
since  through  some  functional  defect  the  morphologic  anomaly  be- 
comes perceived.  Its  characteristic  quality  is,  briefly  stated,  a  quan- 
tity or  quality  of  work  insufficient  to  satisfy  a  standard  of  required 
effectiveness.  The  compensations,  which  in  many  cases  endure  for 
some  time,  consist  in  the  vicarious  replacement  by  a  symmetrically 
placed  organ,  in  the  compensating  aid  of  a  portion  of  an  organ 
related  to  it,  in  the  use  of  another  organ,  or  in  the  heightened  use 
of  the  inferior  organ  itself.  The  provisional  outcome  depends  on 
the  actual  reserve  strength. 

The  pathology  of  these  conditions  exhausts  itself  in  all  conceiv- 
able anomalies  of  execution,  secretion,  and  growth.  The  work  of 
the  organs  or  portions  of  organs  on  which  greater  demand  is  made, 
is  performed  under  heightened  external  and  internal  pressure,  so 
that  at  a  certain  point  of  the  organism  an  increased  condition  of  irri- 
tation must  be  relieved  in  order  to  guarantee  even  unstable  equi- 
librium. Shock  of  any  sort,  infections,  conditions  of  exhaustion, 
overwork  of  a  bodily  or  psychical  nature,  disturbances  in  tempera- 
ture will  usually  show  their  effects  in  this  exposed  place.  It  is 
easy  to  understand  that  even  the  usual  demands  of  life,  of  civiliza- 
tion, at  this  critical  point  also,  the  "  locus  minoris  resistentise,"  may 
be  frequently  followed  by  harm. 

The  observations  on  the  vicariousness  of  symmetrical  organs 
are  old  and  have  to  do  with  inherent  differences  of  form  and  func- 
tion, as  well  as  with  differences  acquired  during  life.  Here  we  can 
cite:  Compensation  of  one  cerebral  half  for  the  other,  just  as  with 
the  halves  of  the  thyroid  gland,  ot  the  lungs,  ^of  the  kidneys,  the 
ovaries,  the  testicles.  If  we  put  aside  the  certainly  determined 
cases  of  inferiority  which  are  but  rarely  found,  we  find  ourselves 


AND   ITS    PSYCHICAL    COMPENSATION  -    7 

forced  to  make  a  diagnosis  of  organic  inferiority  upon  the  estab- 
lishment of  the  phenomena  of  vicariousness  in  cases  that  occur. 
This  condition,  and  the  so  often  observed  increased  tendency  of  in- 
ferior organs  to  grow,  which  I  will  mention  later  on,  and  the  con- 
dition, not  at  all  rare,  of  equal  and  uniformly  divided  anomalies 
in  both  sides,  as  are  found  one-sidedly  in  vicarious  forms,  and  anal- 
ogous conditions  in  asymmetric  organs  on  the  basis  of  primary  in- 
feriority lead  to  the  assumption  that  fust  the  primary  inferior  organs 
seem  predestined  under  certain  conditions  to  take  upon  themselves 
for  a  shorter  or  longer  time  an  increased  functional  activity.  In 
addition  to  the  well-known  types,  emphysema  in  functional  inferi- 
ority of  the  other  lung,  struma  parenchymatosa  lateralis  in  atrophy 
of  the  other  side,  renal  hypertrophy  in  atrophic  processes  of  the 
second  kidney,  etc.,  may  be  cited.  I  should  also  like  to  mention  here 
left-handedness,  partial  situs  viscerum  inversus,  and  the  vicarious- 
ness  of  the  halves  of  the  central  nervous  system.  If  in  all  these 
phenomena  there  is  also  no  doubt  of  inferiority,  they  surely  repre- 
sent merely  a  lesser  degree.  There  can  be  no  doubt  that  the  primary 
inferior  organ  which  frequently  suffers  in  its  deficient  development 
in  size  and  which  is  functionally  not  up  to  the  level  of  a  normally 
developed  organ,  if  it  is  not  forced  to  be  vicarious,  often  has  only 
to  do  a  very  small  amount  of  work.  This  is  apparently  the  reason 
why  it  is  at  times  found  healthy  while  the  vicarious  organ  is  diseased. 
This  condition  was  found  in  the  following  case: 

Miss  Fanny  H.,  23  years  of  age,  comes  of  a  tuberculous  fam- 
ily. Her  mother  died  early  of  pulmonary  phthisis,  a  sister  is  also 
suffering  from  a  pulmonary  disease.  Except  for  children's  dis- 
eases, the  patient  has  not  had  any  notable  sickness.  For  some  time 
there  has  been  a  strong  tendency  to  constipation ;  pallor  of  the  skin 
and  of  the  mucous  membranes  ;  palatal  and  pharyngeal  reflex  lacking. 
In  the  spring  of  the  year  1905  the  patient  began  spitting  blood.  A 
long  sojourn  in  the  South  brought  a  slight  improvement.  In  May, 
1906,  in  the  region  of  the  apex  of  the  right  lung,  diminution  of 
sound  and  a  slight  rattling  during  expiration  could  be  heard.  The 
distance  from  the  spinous  process  of  the  7th  cervical  vertebra 
to  the  processus  coracoideus  was  18  cm.  on  the  right,  on  the  left  16 
cm.  The  patient  said  that  since  her  childhood  the  right  half  of  the 
thorax  had  been  noticeably  more  developed  than  the  left.  Even 
the  breathing  on  the  right  exceeded  that  on  the  left  side.  We  find 
the  focus  of  disease  in  this  case  at  a  point  where  the  fundamental 
inferiority  of  the  respiratory  organs,  which  evinced  itself  clearly 
enough  in  the  heredity,  had  made  good  functionally  as  well  as 


8    •  STUDY   OF   ORGAN    INFERIORITY 

morphologically.  But  in  these  and  similar  cases  it  seems  plausible 
that  the  increase  in  function  and  of  growth  in  an  inferior  organ 
can  also  give  opportunity  for  increased  predisposition  to  disease,  if 
certain  definite  relations  are  disturbed  at  the  same  time.  Sorgo  and 
Schick  recently  pointed  out  that  with  tuberculosis  there  is  often  a 
smaller  nipple  or  a  smaller  areola  on  the  side  of  the  disease  center, 
but  at  times  this  is  true  of  the  other  side.  We  believe  that  we  have 
indicated  the  connection  and  the  explanation  for  this. 

There  surely  are  a  number  of  pure  cases  of  inferiority  in  which 
jwe  do  not  find  vicariousness,  just  as  an  asymmetric  organ  can  re- 
main without  compensation.  My  impression  is  that  in  the  asym- 
metric organs  which  may  be  called  inferior  in  the  majority  of  cases, 
there  are  also  ^partial  compensation  phenomena.  And,  for  this 
reason,  that  general  Inferiority  of  an  organ  or  an  apparatus  rep- 
resents a  certain  degree  of  inability  to  live,  which  gives  sufficient 
cause  for  early  death.  One  can  find  support  for  this  conception  In 
families  where  the  infant  mortality  is  high.  There  need  be  no 
doubt  at  all  of  the  frightful  weight  of  social  conditions,  but,  as  in 
all  other  attacks  of  disease,  the  bulk  is  concentrated  on  the  inferior 
organ.  Most  frequently  we  find  these  compensation  phenomena  in 
the  circulatory  system  and  in  the  gastro-intestinal  tract,  where  they 
occur,  in  accordance  with  the  ruling  theory,  above  all,  to  act  as  a 
temporary  balance  of  mechanical  disproportions  and  conditions. 
Meanwhile  the  organ's  feebleness  alone  makes  it  suspicious.  One 
really  ought  to  accept  the  fact  that  a  training,  more  conformable 
to  nature,  as  on  the  part  of  the  organ  to  overcome  a  usually  slowly 
arising  stenosis  is  scarcely  feasible.  And  yet  in  many  cases  we 
find  such  a  complete  lack  of  compensation  in  a  more  or  less 
short  time.  The  notion  of  an  inferiority  in  the  compensating  seg- 
ment also,  of  which  the  energy  of  growth  is  used  up  only  the  more 
quickly,  explains  this  weakness  a  great  deal.  Add  to  this,  that  we 
are  forced  to  see  an  inferiority  of  the  attacked  part  of  the  organ, 
according  to  this  exposition,  in  the  establishment  and  the  develop- 
ment of  the  centers  of  disease,  an  inferiority  from  which  we  cannot 
without  further  question  exclude  the  adjoining  portions.  We  should 
like  to  extend  similar  demonstrations  to  the  urinary  strictures  and 
to  lithiasis  as  well  as  to  the  compensatory  occurrences  in  the  central 
nervous  system. 

I  can  summarize  briefly  in  regard  to  compensation  of  an  inferior 
organ  by  means  of  a  second  organ.  In  this  line  we  are  accustomed 
to  think  of  cardiac  hypertrophy,  by  which  a  deficiency  in  the  kidney 
or  the  lung  is  compensated.  There  is  no  doubt  as  to  the  facts.  I 


AND   ITS   PSYCHICAL   COMPENSATION  -     9 

will  only  add,  as  above,  that  in  such  cases  many  things  lead  one  to 
call  the  heart  an  inferior  organ  too.  I  should  like  to  say,  besides, 
that  this  group  surely  deserves  much  more  attention  than  it  gets  at 
present.  The  frequent  compensatory  intervention  of  the  brain  in 
deficient  organic  functions  is  undoubted.  But  the  glands  with  ex- 
cretory ducts  also  and  the  ones  with  internal  secretions  can  often 
be  made  to  compensate.  The  disease  phenomena  as  a  whole  are 
often  governed  by  the  disease  of  the  compensating  organ.  The 
results  of  the  pathologic  anatomy  do  not  always  cover  the  disease 
phenomena  that  have  been  found,  since  they  indicate  changes, 
whereas  the  clinic  often  has  to  judge  the  expression  of  relationships. 
Many  diagnostic  errors,  many  failures  in  therapy,  are  rooted  in  this 
not  wholly  clear  connection.  To  be  sure  an  individual  inferiority, 
as  for  instance  of  the  kidney,  can  arise  and  provide  a  symptomatol- 
ogy on  the  grounds  of  a  mechanical,  or  some  such  sort  of  correla- 
tion of  organs.  Above  all  we  must  think  in  this  connection  of  the 
consecutive  disease  of  the  heart,  the  skin,  the  eye  and  the  digestive 
tract,  for  the  relation  of  which  to  kidney  affections,  pathology  offers 
sufficient  authority.  On  the  other  hand,  however,  we  must  empha- 
size the  fact  that  many  of  these  consecutive  seizures  are  compensa- 
tion phenomena  on  inferior  ground  or  "  reactionary  diseases "  in 
other  inferior  organs,  as  in  the  case  of  L.  Z.  in  the  appendix.  From 
the  whole  ensemble  of  inferiority  this  idea  comes  strongly  to  the 
fore,  that  normal  organs  are  compensated  less  by  hypertrophy  and 
more  by  hyperfunction.  On  the  other  hand  the  more  inferior  the 
formation  of  an  organ  is,  the  less  it  has  succeeded  in  functional  de- 
velopment, and  the  sooner  it  will  react  with  excessive  growth  to 
stimuli  of  all  sorts. 

It  is  only  a  step  from  the  fact  of  excessive  growth  in  inferior 
organs  to  the  acceptance  of  the  origin  of  neoplasm  in  such  organs. 
This  seems  to  us  justified  if  we  regard  properly  the  familiar  occur- 
rence, the  anamnestic  particulars,  their  appearance  in  or  near  pri- 
mary inferior  organs.  Whether  parasites  come  into  consideration 
for  individual  neoplasms,  I  must  leave  undecided,  but  do  not  con- 
sider their  part  very  important.  The  anamnestic  data,  particularly, 
speak  for  the  acceptance  of  the  fact  that  neoplasms  originate  only  in 
inferior  organs.  I  could  always  be  sure  in  my  cases,  and  literature 
offers  enough  proofs,  that  the  development  of  the  carcinomas  are 
preceded  by  a  number  of  years  of  functional  disturbances,  or  fur- 
ther disease  of  the  organs,  frequently  of  a  neurotic  nature.  The 
conception  of  a  fundamental  connection  of  lupus,  chronic  catarrh, 
inflammation,  hemorrhages  or  microorganisms  with  the  forming  of  a 


IO  ,  STUDY  OF  ORGAN  INFERIORITY 

carcinoma,  regularly  leaves  the  causal  factor  unexplained.  Ac- 
cording to  our  conception,  all  these  presumed  "  etiologic  "  affections 
are  characterized  in  like  manner  as  the  neoplasms,  as  manifesta- 
tions of  the  inferiority  of  the  diseased  organ.  The  same  is  true  for 
the  origin  of  neoplasms  from  nevus,  in  which  case  the  nevus  pig- 
mentosus  often  betrays  in  unpleasant  fashion  inferior  and  diseased 
organs.  At  least,  I  have  learned  to  watch  for  it  in  my  cases,  and 
have  frequently  found  it  near  the  diseased  organ  in  pulmonary 
tuberculosis,  renal  affections  and  appendicitis.  Since  the  embryonic 
origin  of  nevus  pigmentosus  and  its  familiar  occurrence  has  been 
determined,  furthermore,  since  the  facts  which  lead  to  Cohnheim's 
carcinoma  theory  of  the  scattered  embryonic  germ,  seem  undis- 
turbed, a  confirmation  of  this  theory  of  mine  can  also  be  drawn  from 
his  point  of  view.  Only,  in  place  of  the  scattered  embryonic  germ, 
which  has  not  up  to  the  present  been  established,  the  fetal  character 
of  the  inferior  organ  enters  completely  or  in  one  of  its  parts. 

It  will  not  do  at  all,  however,  to  make  the  proof  of  the  inferior- 
ity of  an  organ  depend  exclusively  on  its  disease.  Only  the  layman 
will  refuse  to  admit  that  a  long  life  is  quite  compatible  with  a  long 
illness.  Even  an  inferiority  does  not  of  necessity  lead  to  an  early 
death.  To  be  sure,  the  outcome  is  determined  by  the  concurrence 
of  deficient  fetal  development,  conditions  of  irritation,  and  material 
reserve  under  stationary  external  requirements.  One  will  find 
changes  of  atrophic  nature,  opposed  to  them  those  of  hypertrophic 
character,  decreased  or  increased  ability,  the  most  varied  anomalies 
of  external  and  internal  secretion,  deficiency  and  excess.  If  in 
addition  we  try  to  take  into  consideration  the  external  conditions, 
the  demands  of  exertion,  infections,  domestication  [Hansemann] 
and  surroundings,  the  diseases  of  over-pressure  and  consumption 
[Edinger]  which  have  just  attained  importance,  localized  infec- 
tious disease,  neoplasms,  appendicitis,  ulcus  rotundum,  hypertrophy 
of  prostate,  etc.,  neuroses,  nervous  diseases  of  peripheral  and  central 
type,  racial  and  family  diseases,  tabes  and  paresis,  all  come  within 
the  field  of  our  calculations. 

The  amount  of  material  to  be  worked  over  is  accordingly  over- 
whelming. In  single  cases,  the  organized  points  of  view  suffice 
to  give  a  survey,  and  to  point  out  the  inferior  organ.  The  deter- 
mination of  the  localization  of  the  disease  is,  and  will  be,  under 
all  conditions,  of  tremendous  importance.  The  framework  of  the 
present  clinical  medicine  is  not  overstepped.  But  it  is  evident  at  once 
that  our  point  of  view  leads  further,  and  puts  us  into  the  position 
to  make  possible  further  understanding  of  the  above-mentioned 


AND   ITS    PSYCHICAL    COMPENSATION  -   II 

process,  since  in  connection  with  the  knowledge  of  sickness  in  many 
cases  there  is  established  also  an  organ  inferiority,  from  the  nature 
and  intensity  of  which  results  are  obtained  which  are  of  value  in 
the  realm  of  etiology,  symptomatology,  and  therapy.  It  is  more- 
over clear  that  new  resources  are  opened  up  for  the  individual  ob- 
servation at  the  sick  bed,  that  is  to-day  very  hazardous,  and  which 
are  particularly  of  value  in  infectious  diseases.  I  can  not  permit 
the  endemic  and  epidemic  diffusion  of  infection  to  count  as  a  serious 
argument  against  the  theory  of  organ  inferiority.  Instead  it  only 
shows  the  relative  inferiority  of  our  extant  organ  cells  in  the  struggle 
with  the  microorganisms.  On  the  other  hand  the  prognosis,  ther- 
apy, and  above  all  the  theory  of  complications  of  disease,  secondary 
diseases  and  sequelae  in  these  cases  also  fall  into  line  with  the  norms 
of  the  inferiority  theory.  The  regard  for  organ  inferiority  will 
attain  greater  surety  in  all  these  questions,  the  better  we  are  able  to 
understand  the  relations  of  the  inferiority.  The  course  of  a  case 
of  diphtheria  surely  depends  primarily  on  the  antitoxic  power  of 
the  organism,  on  the  active  or  passive  immunizing  power,  but  the 
value  of  the  heart,  kidney  and  respiratory  apparatus  also  comes  into 
consideration  for  the  crisis. 

Besides  the  inferiority  of  an  organ  does  not  need  to  reveal  itself 
throughout  a  whole  lifetime,  or  the  expression  may  remain  so  insig- 
nificant that  one  scarcely  thinks  that  one  has  an  inferior  organ  before 
one,  or  else  it  expresses  itself  in  morphologic  anomaly  and  even 
then  at  times  so  slightly  that  the  condition  of  the  individual  is  not 
affected.  Slight  deviations  also,  at  times  in  the  most  primitive  func- 
tions, may  represent  the  whole  of  the  inferiority,  which  at  other 
times  may  lead  to  disease  and  death  in  the  victim.  A  significant 
light  is  thrown  on  the  nature  of  organ  inferiority  by  the  frequent 
phenomenon  of  manifold  inferiority  in  the  organs  of  a  person  and 
the  part  played  by  the  brain  and  spinal  cord  in  connection  with  it, 
which  frequently  act  compensatingly  and  cover  the  existing  defect 
or  else  shape  it  to  useful  ends.  In  the  following  pages  then  we 
shall  discuss: 
I.  Heredity. 
II.  Anamnestic  demonstration. 

III.  Morphologic  characteristics. 

IV.  Reflex  anomalies  as  indications  of  inferiority. 
V.  Manifold  organ  inferiorities. 

VI.  The  part  played  by  the  central  nervous  system  in  the  theory  of 
organ  inferiority.  Psychogenesis  and  foundations  of  neu- 
roses and  psychoneuroses. 


CHAPTER   II 
I.  HEREDITY 

Here  we  find  ourselves  on  familiar  ground.  The  significance 
of  heredity  however  is  esteemed  differently  by  different  investi- 
gators. Some  bring  forward  the  family  anamnesis,  refer  every 
exact  conclusion  back  to  that  and  want,  at  best,  to  deduce  from  is 
greater  or  lesser  predisposition  to  disease.  Others,  particularly 
more  recent  writers  find  very  nearly  similar  hereditary  conditions  in 
healthy  as  in  sick  individuals,  and  they  put  aside  all  deeper  mean- 
ings of  the  problem  of  heredity.  For  the  most  part,  the  con- 
ception of  the  ability  to  inherit  a  temperament  which  under  suit- 
able conditions  leads  to  hereditary  disease  is  prevalent.  As  far  as 
we  can  determine  French  students  have  always  inclined  to  place 
sharper  emphasis  on  heredity  than  German  students. 

There  have  also  been  contradictions,  which  we  think  can,  with- 
out very  great  difficulty,  be  put  aside.  In  the  foreground  of  our 
assertions  regarding  heredity  belongs  this  sentence:  Heredity  con- 
sists in  inheriting  one  or  more  inferior  organs. 

A  survey  of  the  diseases  regarded  as  hereditary  supports  this  as- 
sertion, which  contradicts  the  conception  of  hereditary  degeneration 
of  the  whole  organism.  Even  that  which  is  called  mixed  heredity, 
as  in  epilepsy,  mental  disturbances,  hysteria,  chronic  alcoholism,  etc., 
may  be  classified  according  to  individual  inferior  organs,  wherein 
the  influence  and  development  of  the  central  nervous  system  is  strik- 
ingly noticeable.  We  will  have  now,  at  this  point,  to  lay  down  a 
fact  which  is  of  the  greatest  importance  for  the  whole  conception 
of  our  work.  The  inferiority  of  an  organ  may  reveal  itself  in  the 
descendants  in  the  most  diverse  parts  of  the  organ.  With  this 
statement  a  great  number  of  contradictions  to  the  theory  of  heredity 
are  removed.  Above  all  "mixed  heredity"  is  reduced  to  a  simple 
hereditary  inferiority  of  the  nervous  system.  But  those  investi- 
gators are  in  the  right  too,  who  attribute,  regardless  of  seeming 
contradiction,  the  greatest  significance  to  the  heredity  problem, 
despite  the  fact  that  sick  children  may  come  from  healthy  parents 
or  individual  healthy  children  from  diseased  parents.  For  from 
the  most  different  sorts  of  localization  of  inferiority  in  the  organ 
and  its  appertaining  parts  there  naturally  arise  widely  differing 

12 


STUDY  OF  ORGAN   INFERIORITY  13 

degrees  of  vitality  and  predisposition  to  disease.  We  must  how- 
ever consider  that  there  are  a  great  number  of  forms  of  inferi- 
ority which  plainly  injure  neither  health  nor  duration  of  life,  such, 
particularly,  as  mild  functional  or  peripherally  situated  inferiorities. 

In  our  work  we  recognize,  not  the  heredity  of  the  disease  but 
the  heredity  of  the  inferior  organ,  a  conception  which  has  not  yet 
made  a 'way  for  itself  in  all  pathology,  but  has  probably  been  ac- 
cepted for  individual  pathologic  phenomena.  We  wish  to  try  to  de- 
fend our  idea  and  to  introduce  further  support  than  that  which  has 
hitherto  belonged  to  it  in  a  series  of  diseases  which  have  usually 
been  considered  hereditary. 

The  introduction  of  heredity  in  cases  of  genuine  epilepsy  seems 
comparatively  free  from  objections.  The  anomalies  of  form  in  the 
brain  emphasized  by  Meynert  and  others  coincide  with  our  morpho- 
logic inferiorities.  We  shall  have  to  lay  claim  to  the  epileptic  equiva- 
lent, the  imbecility  which  occurs,  as  a  functional  inferiority  of  the 
brain.  The  etiological  importance  of  polioencephalitis  discussed  by 
Freud  and  Rie  is  found  in  its  appearance  as  a  form  of  disease  of  an 
inferior  organ,  namely  the  brain.  In  our  opinion  other  diseases 
which  have  been  emphasized  are  connected  with  a  similar  inferi- 
ority of  other  organs.  This  is  the  case  in  the  frequent  anamnestic 
determination  of  nocturnal  enuresis,  a  functional  inferiority  of  the 
urinary  appartus,  which,  in  favorable  cases,  may  be  counterbalanced 
by  compensation  of  the  central  nervous  system.  The  anomalies  of 
the  circulatory  organs,  also,  which  are  on  many  sides  connected  with 
the  question  of  epilepsy,  may  be  thus  compensated.  Asymmetry  of 
the  base  of  the  skull,  ocular  anomalies,  signs  of  degeneration  in  the 
head  continually  direct  our  attention  to  the  inferiority  of  the  brain, 
and  are  to  be  counted  as  peripheral  expressions  of  this  inferiority. 
Changes  in  the  reflexes  of  the  mucous  membranes  and  the  skin,  as 
Redlich  recently  indicated,  rest  upon  similar  inferiority  of  other 
organs.  Moral  deterioration,  criminality,  chronic  alcoholism,  may 
arise  from  this  cerebral  inferiority,  but  not  epilepsy.  Decided 
mental  predisposition,  genius  which  Lombroso  has  brought  to  the 
foreground,  may  be  considered  as  over-compensation  in  an  inferior 
brain.  It  is  this  inferior  brain  which  may  be  inherited.  In  order 
to  lead  to  epilepsy,  there  must  be  further  determinations.  Crim- 
inals, drinkers,  imbeciles,  inventive  people,  geniuses,  apparently 
healthy  people,  who  however  frequently  reveal  peripheral  or  partial 
forms  of  inferiority,  have  to  alternate  in  such  families  till  this  stock 
is  destroyed  by  external  circumstances  or  until  an  equilibrium  is 
reached  which  guarantees  better  vitality. 


14  STUDY  OF  ORGAN  INFERIORITY 

t 

Take  for  example  the  L.  family:  The  father  died  of  carcinoma 
of  the  bladder,  the  mother  was  mentally  inferior.  There  were  two 
sons,  of  whom  one  was  feeble-minded  with  asymmetry  of  the  skull, 
the  other  normal.  Of  five  daughters  the  oldest  is  afflicted  with  renal 
calculus,  one  of  her  children  wets  his  bed.  The  second  suffered 
during  her  childhood  from  enuresis  and  catarrh  of  the  bladder, 
later  in  each  pregnancy — three  times — from  pregnancy  pyelitis. 
The  third  is  an  epileptic,  the  fourth  an  imbecile,  the  fifth  normal. 
Of  the  children  of  the  second  daughter,  the  first  shows  slight  symp- 
toms of  enuresis,  the  second  has  deformities  of  the  skull,  the  third 
suffered  from  spasm  of  the  glottis.  In  this  family  accordingly,  a 
combination  of  inferiority  of  the  urinary  apparatus  and  of  the  brain 
plays  its  unfortunate  part. 

The  analysis  of  the  conditions  of  heredity  in  tuberculous  cases 
proves  itself  equally  fruitful.  The  justification  of  the  problems  of 
heredity  in  the  tuberculosis  question  is  pretty  well  recognized.  It 
becomes  still  more  clear  on  accepting  our  viewpoint,  as  long  as  one 
does  not  seek  in  the  ascendancy  only  tuberculosis  of  the  lungs 
but  lays  greater  stress  on  the  inferiority  of  the  whole  respiratory 
tract,  and  takes  the  same  attitude  toward  diseases  of  this  apparatus. 
Then  bronchial  asthma,  emphysema,  diseases  of  the  larynx,  of  the 
pharynx,  of  the  nose,  also  fall  into  the  range  of  the  anamnesis. 
For  just  as  the  inferior  brain  in  epilepsy  is  transmitted  so  it  is  the 
inferior  respiratory  organ  in  tuberculosis,  which  reveals  deficiencies 
at  the  most  diverse  places,  and  in  the  most  widely  different  forms. 
We  may  not  leave  the  complicating  diseases  unmentioned  either. 
The  connection  between  gastro-intestinal  affections,  hysteria,  goiter, 
alcoholism,  and  albuminuria  is  sufficiently  clear.  It  would  lead  us 
too  far  afield  to  give  a  complete  explanation  of  this  connection  at 
this  point. 

As  a  result  of  my  investigations,  I  can  allege,  that  in  all  these 
cases,  to  which  we  must  also  add  smallness  of  the  heart  and  of  the 
arteries,  it  is  not  a  question  of  pure  connection  of  a  causal  nature, 
but  has  to  do  with  inferiority  in  a  second  organ  appearing  at  the 
same  time.  Localization  in  the  apex  of  the  lung  is  particularly  in- 
teresting. It  may  be  best  explained,  in  our  opinion,  by  accepting  a 
particular  inferiority  at  this  point.  The  Frankel  constriction  of  the 
upper  thoracic  opening,  the  prominent  angulus  ludovica,  the  phthisic 
constitution,  the  deficient  development  of  the  areola  of  the  nipple 
on  the  diseased  side,  emphasized  by  Sorgo  and  Schick,  are  nothing 
more  than  peripheral  indications  of  the  inferiority  of  the  respira- 
tory organs,  and  are  surely  not  to  be  valued  etiologically,  any  more 


AND    ITS    PSYCHICAL    COMPENSATION  15 

than  the  diminished  exchange  of  air  at  the  apex.  All  these  signs 
are  not  found  in  phthisis  subjects  only,  but  are  none  the  less  sus- 
picious factors.  The  striking  size  of  the  lung  in  phthisis  gives  em- 
phasis to  that  factor  of  growth  tendency  in  inferior  organs  of 
which  we  have  already  spoken.  One  can  not  avoid  a  similar  im- 
pression in  watching  the  growth  of  giant  cells.  On  the  other  hand 
the  part  of  the  tubercle  bacilli  as  well  as  the  social  conditions  are 
assured  to  be  determining  factors. 

E.  family:  The  father  has  emphysema  and  chronic  bronchitis, 
the  mother  died  of  hemorrhage,  in  a  premature  birth.  Of  the  sons, 
the  elder  is  healthy;  the  younger  in  his  twenty -third  year  became 
ill  with  pleuritis  on  the  left  side,  affection  of  the  apex  on  the  left  side 
and  albuminuria.  He  suffered  from  chronic  coryza,  swelling  of  the 
pharyngeal  tonsil  and  of  the  turbinates.  The  older  sister  suffered 
from  spasmodic  sneezing  (unfortunately  we  can  get  no  report  about 
it)  and  in  her  thirty-fifth  year  underwent  an  operation  for  myoma. 
The  younger  sister  in  her  childhood  suffered  from  enuresis  and  fre- 
quently had  nasal  catarrh  and  recurring  laryngitis.  The  older  sister 
is  childless,  the  younger  had  three  difficult  births,  in  which  hydram- 
nios  was  present  with  extraordinarily  large  children.  There  were  no 
noteworthy  change  in  the  pelvic  measurements.  In  this  family  may 
be  listed,  inferiority  of  the  respiratory  organs  in  different  places  and 
in  different  forms,  also  inferiority  of  the  sexual  organs  of  the  female 
members.  If  I  add  that  the  father  and  paternal  grandfather  suffer 
from  catarrh  of  the  bladder  owing  to  hypertrophy  of  the  prostrate 
[pr o stats  —  tit erus  masculinust},  we  will  have  to  grant  inferiority  of 
the  urinary  apparatus  also,  considering  bed-wetting  and  albuminuria 
of  the  younger  children  at  the  same  time,  an  inferiority  which  like 
the  others  is  of  account  in  heredity. 

There  is  a  whole  list  of  diseases  which  can  be  passed  down  by 
heredity,  which  I  can  either  omit  or  else  mention  briefly  because 
they  have  little  weight  for  the  material  which  is  to  be  demonstrated 
in  this  chapter,  or  else  can  not  be  verified  by  me  with  sufficient 
material.  Such  is  the  case  in  diabetes,  the  hereditary  significance  of 
which  is  universally  recognized.  The  assumption  of  an  inferiority 
of  the  pancreas,  also,  regarding  its  nervous  connection  with  the 
medulla  oblongata  would  meet  with  only  slight  opposition.  The 
principle  determination  seems  more  important  to  me,  namely  that  in 
diabetic  families  the  alimentary  tract  is  inferior,  a  fact  which  may, 
in  the  individual  family  members,  not  always  come  to  light  in  the 
pancreas,  but  in  various  parts  and  with  varying  strength  in  this  ap- 
paratus and  its  appertaining  portions,  in  the  mouth,  teeth,  pharynx, 


1 6  STUDY   OF   ORGAN    INFERIORITY 

» 

stomach,  liver,  intestine,  and  rectum.  In  this  connection  I  consider 
it  necessary  to  call  attention  to  the  numerous  gastro-intestinal  com- 
plaints found  in  diabetic  cases,  and  particularly,  to  the  frequent  lack 
of  palatal  reflex  which  indicates  a  deep-seated  change  in  the  whole 
alimentary  tract.  The  connections  between  diabetes  and  obesity, 
gout  and  formation  of  gall-stones,  and  the  alternating  appearance  of 
these  diseases  in  individual  families  can  only  rest  on  the  common 
foundation  of  inferiority  of  the  gastro-intestinal  apparatus.  Other 
groupings,  such  as  tuberculosis,  disease  of  the  vessels,  skin  affec- 
tions, renal  changes,  Basedow's  disease  neuroses,  which  are  often 
found  in  diabetic  subjects,  we  shall  regard  as  an  expression  of  the 
simultaneous  inferiority  of  a  second  organ,  which  may  be  more  or 
less  burdened  by  the  diabetic  disturbance  of  metabolism. 

For  example  in  his  thirteenth  year,  O.  C.  became  ill  with  severe 
diabetes.  In  his  early  childhood  up  until  his  fifth  year  he  suffered 
from  involuntary  defecation,  later  from  constipation  and  diarrhea. 
In  his  twelfth  year  severe  furunculosis  set  in,  which  aroused  sus- 
picions of  diabetes.  The  father  suffered  from  gall-stones  in  his 
youth,  was  inclined  to  obesity,  and  has  for  many  years  been  tor- 
mented by  stubborn  constipation.  The  mother  shows  numerous 
recurrences  of  urticaria.  A  sister  has  hysteria.  The  analysis  of 
the  case  follows  from  the  previous  one.  The  inferiority  of  the  in- 
testinal apparatus  comes  from  the  paternal  side,  which  is  distin- 
guished everywhere  by  obesity.  To  this  the  mother  adds  the  in- 
ferior skin,  which  furnishes  the  ground  for  furunculosis.  Not  one 
of  the  four  members  of  the  family  shows  a  palatal  reflex  and  the 
pharyngeal  reflex  can  only  be  obtained  with  difficulty. 

A  theory  of  diabetes  must  rest  on  the  acceptance  of  an  inferior 
pancreas.  The  deficient  pathologic  reports  in  this  disease  make 
for  a  preponderating  functional  inferiority,  which  might  make  itself 
felt  in  anomalies  of  secretion.  Yet  at  times  a  morphologic  inferi- 
ority (of  the  parenchyma,  abnormal  smallness  of  the  islands  of 
Langerhans)  can  be  definitely  proved.  Thirdly  the  inferiority  may 
be  situated  in  the  nerve  connections  of  the  pancreas. 

Case  of  Dr.  G.:  The  father  suffered  from  exophthalmic  goiter. 
The  son  has  been  afflicted  since  his  childhood  with  severe  diabetes. 
Thyroid  gland  intact.  Here  we  find  inferiority  of  two  organs  at 
the  same  time,  without  being  able  to  say  anything  about  their  mutual 
influence.  This  case  requires  us  not  so  much  to  connect  exclusively 
the  sugar  secretion  with  the  thyroid  in  the  not  at  all  rare  glycosuria 
in  cases  of  exophthalmic  goiter,  but  rather  to  accept  a  simultaneous 
inferiority  of  the  pancreas. 


AND    ITS    PSYCHICAL    COMPENSATION  17 

In  regard  to  obesity,  I  must  emphasize  at  this  point  that  it  has 
been  emphatically  proved  to  be  hereditary.  This,  as  well  as  its 
connection  with  other  diseases,  namely  with  simultaneous  inferiority 
of  other  organs,  is  sufficiently  well  known. 

Diseases  of  the  lymphatic  glands  are  not  considered  hereditary 
as  far  as  I  know.  The  reason  for  this  is  in  the  following:  As  soon 
as  tuberculosis  has  been  determined  in  an  organ,  in  many  cases  all 
further  interest  seems  at  once  to  die  out  in  the  investigator  or  else 
is  directed  to  the  modes  and  means  of  spreading  the  infection.  We 
are  however  interested  above  all  in  the  fact  that  tuberculosis  may 
attack  every  inferior  organ  under  certain  conditions.  The  inferiority 
of  the  lymphatic  glands,  which  is  surely  of  the  greatest  importance 
in  the  further  advance  of  tuberculosis,  is  inborn  and  hereditary. 
Two  cases  will  serve  as  support  for  this  view. 

I.  Alfred  B.  in  his  sixteenth  year  became  ill  with  numerous 
swellings  of  lymphatic  glands  of  the  neck,  all  of  which  showed 
softened,  puslike,  disintegrated  material  and  which  healed  with  the 
well-known  scrofulous  scars.     Neither  the  patient  nor  any  one  else 
in  the  family  showed  signs  of  tuberculosis.     But  the  mother  in  her 
fifteenth  year  had  also  had  swellings  of  the  lymphatic  glands  of  the 
neck  and  showed  a  few  scrofulous  scars. 

II.  Frieda  H.,  fifteen  years  old,  had  always  been  well  up  to  the 
winter  of  1905.    At  that  time  she  suffered  from  countless  tumors 
of  the  lymphatic  glands  which  particularly  filled  out  and  caused  the 
supraclavicular  depressions  to  bulge.     To  this  pleuritis  on  the  left 
side,  and  later,  swellings  of  the  lymphatic  glands  under  the  left 
axilla  were  added.     Her  parents  and  brothers  and  sisters  are  healthy, 
and  have  never  suffered  from  swellings  of  the  lymphatic  glands. 
But  an  uncle  on  the  mother's  side  did  have  them.     The  patient's 
older  sister  has  a  nevus  pigmentosus  (see  previously)   in  the  left 
supraclavicular  hollow.     The  mother  also. 

In  such  cases  we  can  only  speak  of  inherited  inferiority  of  the 
lymphatic  glands,  not  of  hereditary  tuberculosis. 

Following  this  conception  we  find  ourselves  forced  to  draw  the 
following  important  conclusions,  which  have  a  bearing  on  tubercu- 
losis as  well  as  on  all  other  infectious  diseases. 

1.  All  infections  which  may  be  overcome  by  the  natural  pro- 
tective power  of  the  organism  threaten  most  of  all  that  organ  which 
has  least  of  this  protective  power  and  which  in  the  majority  of 
cases  is  the  inferior  organ. 

2.  In  tuberculosis  especially  a  therapeutic  result  is  only  to  be 
hoped  for  in  so  far  as  it  is  possible  to  promote  the  inferior  organ 


1 8  STUDY   OF   ORGAN    INFERIORITY 

i 

far  enough  for  it  by  its  own  strength  to  overcome  the  infection. 
As  far  as  therapy  with  sera  is  concerned,  the  greater  chances  fall 
to  active  immunization.  Only  in  passive  immunization  can  indi- 
vidual parasites  remain  viable,  and  the  inferior  organ  again  falls 
a  sacrifice  to  the  next  spread  of  infective  material. 

We  do  not  wish  to  close  this  chapter  without  taking  into  con- 
sideration the  question  of  carcinoma  in  so  far  as  it  belongs  here. 
In  this  it  is  of  little  importance  whether  we  pursue  the  question 
according  to  the  parasitic  or  non-parasitic  etiology.  We  only  re- 
move the  etiologic  moment  a  layer  deeper.  Carcinoma  can  only  be 
developed  in  an  inferior  organ.  Further  conditions  are  unknown 
so  far.  A  list  of  facts  supports  our  conception  which  is  most  closely 
allied  to  Billroth's  work  on  carcinomatous  predisposition.  There 
is  also  the  development  of  carcinoma  in  the  previous  history  of  the 
diseases  of  the  organ.  The  present  conception  regards  previous  dis- 
eases as  of  importance  etiologically ;  we,  however,  according  to  our 
discussions  consider  them  as  of  historic  importance.  All  the  changes 
of  the  organs  in  the  anamnesis  of  the  carcinoma,  whether  of  ca- 
tarrhal,  inflammatory-infectious  nature,  of  hypertrophic  or  atrophic 
character,  all  prove  this  organ  to  be  primarily  inferior.  I  have 
spoken  of  that  in  this  chapter.  Furthermore  I  call  attention  to  the 
remarkable  variability  and  growth  energy  of  carcinoma  cells,  which 
reveal  a  capacity  similar  to  embryonic  growth.  Of  the  same  sort  is 
the  condition  of  giant  cells  and  also  embryologic  tissue.  I  have 
already  emphasized  the  significance  of  nevus.  I  consider  its  relation 
to  inferiority  to  be  quite  definite.  Its  relation  to  carcinoma  has 
long  been  a  well-known  one.  Besides  I  can  introduce  here  the 
whole  Cohnheim  argument  and  the  collection  of  illustrative  cases 
connected  with  it,  with  the  exception,  that  I  have  to  drop  the  idea 
of  "  scattered  embryonic  germs  "  and  substitute  in  its  place  organ 
inferiority,  with  its  very  nearly  embryonic  character.  The  hered- 
itary significance  of  carcinoma  also  I  think  can  be  proved,  to  be 
sure,  in  another  sense  from  that  which  other  authors  give  it.  The 
inferiority  of  the  organ,  not  the  carcinoma,  may  be  inherited.  There 
are  other  things  required  for  the  origin  of  a  carcinoma.  The  inferi- 
ority of  the  organ  can  however  be  proved  from  the  genealogy. 

Mrs.  A.  B.  was  taken  sick  in  her  fifty-eighth  year  with  carcinoma 
of  the  left  breast.  Her  daughter,  Mrs.  L.  T.,  showed  deficient  de- 
velopment of  the  nipples  on  both  sides  and  was  incapable  of  suck- 
ling in  spite  of  all  efforts.  As  a  striking  feature,  note  that  a  fairly 
thick  circle  of  hair  surrounds  both  nipples,  a  condition  which  re- 
minds us  of  the  hairiness  in  spina  bifida,  another  morphologic  in- 
feriority. 


AND   ITS    PSYCHICAL   COMPENSATION  ,    1 9 

Mrs.  Theresa  S.  died  in  her  forty-sixth  year  during  an  operation 
for  carcinoma  of  the  uterus.  Her  son  as  well  as  her  daughter's  son 
suffered  from  enuresis.  The  daughter  has  attacks  of  vomiting 
and  diarrheal  stools  whenever  she  is  the  slightest  bit  excited.  This 
case  offers  proof  only  for  those  who  accept  with  me  the  law  of 
manifold  inferiority  of  organs  and  follow  my  view  still  further,  ac- 
cording to  which  enuresis  as  well  as  stomach  and  intestinal  neuroses 
rest  on  functional  inferiority  of  the  related  organs. 

The  case  of  L.  (see  above)  might  also  be  quoted  here. 

Case  of  J.  K.:  Sensibility  to  pressure  in  the  gastric  region, 
radiating  pains  to  the  left  as  far  as  the  region  of  the  left  shoulder 
blade,  heightened  spontaneous  pains  after  taking  nourishment,  vomit- 
ing. A  pale  person,  a  cook.  No  palatal  reflex,  pharyngeal  reflex 
positive.  Father  died  of  cancer  of  the  stomach.  Here  also  the 
inheriting  of  an  inferior  organ  reveals  itself,  but  also  the  choice  of 
profession,  influenced  by  the  fundamental  inferiority  of  the  diges- 
tive organ,  all  of  which  is  to  be  discussed  later  (V),  and  the  de- 
ficiency of  the  palatal  reflex,  a  sign  of  the  inferiority  of  the  ali- 
mentary tract  which  we  still  have  to  discuss  (IV). 

Case  of  Mrs.  Nadja  J.:  For  four  years  she  suffered  from  hys- 
terical attacks,  which  were  accompanied  by  unconsciousness.  On 
her  right  cheek,  at  the  height  of  the  nostril  and  about  2  cm.  side- 
ways from  the  nose,  we  find  a  nevus  pigmentosus.  Her  mother  had 
been  operated  on  two  months  before  for  carcinoma  of  the  left 
superior  maxilla.  Here  it  is  evidently  a  question  of  segmentary  (of 
which  more  later)  inferiority  in  the  region  of  the  upper  jaw,  the 
presence  of  which  in  the  family  is  revealed  in  the  mother  and 
daughter. 

To  conclude,  I  will  briefly  point  out  that  the  great  majority  of 
carcinomas  are  found  in  such  positions  as  have  been  specially  named 
by  Freud  erogenous  zones  and  which  he  has  brought  into  close  con- 
nection with  the  neuroses.  Such  zones  are  mouth,  anus,  breast,  gen- 
ital region,  etc.  The  connection  between  neuroses  and  inferior  or- 
gans is  discussed  in  another  place. 

The  other  branches  of  the  heredity  theory  may  be  classified  in 
a  similar  manner.  I  have  myself  found  myomas  in  mother  and 
daughter,  and  in  sisters.  If  one  holds  to  the  ideas  already  outlined 
the  inferiority  of  organs  can  often  be  traced  in  the  genealogy. 

I  pass  over  the  whole  list  of  diseases  conceded  to  be  hereditary, 
but  must  point  out  briefly  that  in  a  great  number  of  these,  not  only 
just  in  the  center  of  the  disease  but  in  the  region  of  apparently  healthy 
organs,  trustworthy  observers  have  indicated  changes  of  atrophic  or 


2O  STUDY  OF  ORGAN  INFERIORITY 

^ 

hypertrophic  nature.  One  can  not  challenge  such  a  report  uncon- 
ditionally. But  it  is  in  the  nature  of  the  thing  that  in  an  organ 
inferiority  subject  to  inheritance,  not  only  to  individual  portions  of 
the  organ  predestined  as  a  center  of  disease  show  the  character  of 
the  inferiority,  whether  it  is  pure  or  especially  functional  or  mor- 
phological, which  last  phenomenon  is  to  be  considered  as  a  reaction 
of  the  inferior  material  under  the  relatively  greater  vital  irritation, 
but  also  adjacent  or  more  remote  elements  of  the  inferior  organ. 
Now  there  would  be  nothing  more  out  of  the  way  than  to  insist 
upon  finding  again  all  the  anomalies  of  the  ancestors  to  the  same 
extent  in  one  of  the  descendants,  in  an  investigation  on  the  nature 
and  compass  of  heredity.  Just  as  heredity  can  appear  at  different 
parts  of  the  organ,  where  it  is  found  in  the  form  of  functional  or 
morphological  inferiority,  which  gives  footing  for  any  sort  of  dis- 
ease of  a  parasitic  or  non-parasitic  nature,  so  the  fact  has  to  be 
reckoned  with  that  in  later  life,  under  the  influence  of  the  manner  of 
living,  inferiority  unconcealed  or  revealed  by  illness,  will  not  always 
be  found.  Perhaps  it  happens  just  as  often  that  in  place  of  the 
expected  inferiority,  nothing  abnormal  or  directly  an  excess,  or 
even  an  exaggerated  peculiarity  is  found. 


CHAPTER  III 

ANAMNESTIC  DEMONSTRATION 

In  the  above  we  have  repeatedly  thought  of  the  difficulties  which 
at  times  stand  in  the  way  of  classifying  an  organ  as  inferior.  As 
we  use  it  the  idea  of  full  normality  on  the  part  of  an  organ  is  not 
at  all  the  same  thing  as  the  term  health  and  for  the  following  reasons. 
There  may  have  been,  either  by  reason  of  appropriation  of  reserve 
growth  power  at  the  place  of  the  inferiority  itself  or  more  remote 
from  it,  in  a  second  organ  or  in  the  nerve  track,  compensation, 
which  has  hidden  the  deficiency,  and  even  conceals  it  from  the  medi- 
cal investigator.  Or  else  the  inferiority  reveals  itself  in  one  member 
of  the  family  in  a  place  where  there  is  little  or  no  disturbance  in 
the  healthy  functioning  of  the  organ.  In  another  member  the  in- 
feriority may  appear  as  a  disturbance  of  health.  Or  else  the  favor- 
ableness  of  external  conditions,  public  and  private  hygiene,  enable 
the  individual  burdened  with  an  inferiority  to  escape  dangers  to 
health,  which  present  themselves  at  once  when  the  social  position, 
working  time,  home  or  nourishment,  become  worse.  To  be  sure 
here  it  is  a  question  of  a  lesser  degree  of  inferiority.  The  higher 
degrees  condition  either  incapacity  for  life  or  else  are  actually  hidden 
by  the  so-called  "  diseased  "  organ. 

I  wonder  whether  there  are  any  criteria  for  distinguishing 
"healthy"  organs  from  inferior  ones.  We  have  already  shown 
how  the  theory  of  heredity  may  serve  us  as  a  clue.  According  to 
our  conception  an  organ  may  be  found  to  be  quite  healthy,  but  in- 
ferior owing  to  its  heredity.  In  such  cases  it  is  absolutely  neces- 
sary to  get  the  history  of  youth,  or  perhaps,  better  still,  the  childhood 
history  of  the  organ,  because  at  times  it  is  possible  to  determine 
the  inferiority  which  escapes  the  perception  the  moment  com- 
pensation sets  in.  As  soon  as  the  inferiority  of  an  organ  comes 
into  account,  before  compensation  in  early  childhood,  it  appears 
preponderatingly  as  a  functional  deficiency  or  as  a  deficiency  in  func- 
tional control  on  the  part  of  the  child.  Besides  the  diseases  from 
which  the  child  has  recovered,  the  anamnestic  significance  of  which 
is  recognized,  the  same  attention  is  due  to  the  development  of  the 
sensory  functions  and  the  vegetative  organs,  to  learning  to  walk  and 
talk,  to  the  control  of  childish  errors.  Even  with  very  little  ma- 

21 


STUDY   OF   ORGAN    INFERIORITY 

terial  the  significance  of  this  anamnesis  in  childhood  seems  deter- 
mined. And  in  a  special  example  of  childish  fault,  namely  bed-wet- 
ting, we  will  furnish  at  the  close,  proof  of  its  significance  and  a 
few  illustrative  cases  given  which  show  the  relation  to  organ  in- 
feriority. If  we  add  the  conception  maintained  in  the  discussion 
of  problems  of  heredity,  we  have,  as  further  basis  of  investigation, 
the  principle  that  a  fault  of  childhood  in  the  inheritance,  in  parents, 
children,  brothers  and  sisters  of  the  patient  should  be  regarded  as  a 
suspicious  sign  of  the  inferiority  of  the  organ  relating  to  the  fault. 
The  same  is  true  of  compensation  or  over-compensation  which  can 
be  proved  in  heredity. 

Of  the  anomalies  of  childhood  development  which  are  found  in 
the  history  constipation,  vomiting,  blinking,  squinting,  stuttering, 
sucking  the  thumb,  and  lack  of  control  of  the  bowels  or  of  the 
urine  should  be  particularly  emphasized.  Furthermore  it  seems  of 
importance  to  emphasize  the  fact  that  the  infantile  trace  of  organ 
inferiority  frequently  impresses  itself  as  a  functional  failure  of  the 
organ  in  domestication.  This  demands  the  control  of  organ  ac- 
tivities and  at  the  same  time  the  giving  up  of  the  pleasurable  sen- 
sation which  unhindered  organ  activity  brings.  The  limitation  of 
organic  sensory  pleasure  for  the  benefit  of  cultural  progress  becomes 
the  test  of  organic  normality.  At  other  times  the  domestication 
[Hansemann]  requires  functioning  under  limiting  conditions,  with 
insufficient  air,  unsuitable  food,  poor  light.  The  harm  which  this 
does  the  child  affects  primarily  the  inferior  organs,  which  are  not 
equal  to  such  a  strain  on  their  function.  Deficient  growth  of  bones, 
of  the  organs  of  respiration  and  circulation,  the  digestive  apparatus, 
the  central  nervous  system,  of  the  blood  organ,  are  caused  thereby. 

In  other,  more  fortunately  situated  cases,  a  functionally  superior 
formation  gets  the  patient  out  of  difficulty.  A  particular  viewpoint 
has  taught  me  how  often  a  morphologic  or  functional  deficiency  of 
an  organ  is  converted  to  a  higher  development  of  that  organ.  The 
stuttering  boy  Demosthenes  becomes  the  greatest  orator  of  Greece, 
and  up  to  the  present  day  we  seldom  find  any  such  heaping  up  of 
defects  of  speech  and  signs  of  degeneration  of  the  mouth,  as  are 
observed  in  orators,  actors  and  singers. 

The  anamnestic  significance  of  childish  faults  in  neuroses  has 
already  been  emphasized,  and  accentuated  in  its  full  importance  by 
Freud.  It  yet  remains  for  us  here  to  refer  to  the  tendency  to 
greater  sensory  development,  found  in  the  peripheral  part  of  the 
inferior  organ  especially,  portions  of  which  are  exposed  near  the 
skin  surface.  In  part  this  increased  sensibility,  the  starting  point 


AND   ITS    PSYCHICAL    COMPENSATION  23 

of  many  child- faults,  surely  comes  from  the  impotence  of  the  in- 
ferior organ  which  can  not  of  itself  follow  the  safe  pathway  of  cul- 
tural functioning ;  for  it  is  the  cause  of  every  organic  activity,  while 
the  cultural  organic  function  draws  its  strength  from  repressed 
sensory  pleasure.  How  closely  this  raising  of  the  sensory  com- 
ponent is  related  to  the  embryonic  nature  of  the  inferior  organ  I 
can  not  determine  definitely.  But  it  is  true  that  the  ensemble  of 
phenomena  of  organ  inferiority  is  reflected  on  the  psyche  in  such 
a  manner,  that  its  whole  structure  has  a  peculiar  impression.  The 
psychical  steucture^Lhus  obtained  becomes  a  foundation  for  neuroses 
and  psychoses. 

Whereas  scarcely  a  single  case  of  neurosis  is  without  such  a 
history  from  childhood,  to  which  Freud  has  already  made  specific 
reference,  I  can  only  offer  scant  material,  aside  from  the  illustrative 
cases  following  in  the  conclusion.  Yet  in  a  number  of  cases,  for 
instance  in  diabetic  subjects,  I  could  be  sure,  that  since  earliest 
childhood,  intestinal  function  was  not  what  it  should  have  been.  I 
often  found  constipation  present,  more  rarely  involuntary  defeca- 
tion. The  frequency  of  gastro-intestinal  disturbances  in  developed 
diabetes  justifies  the  theory  that  this  disease  depends  upon  a  hered- 
itary inferiority  of  the  gastro-intestinal  apparatus,  which  appears 
predominantly  in  the  function  of  the  related  gland,  the  pancreas  and 
at  times  in  the  liver  also.  A  few  cases  to  justify  this  assumption. 

Margit  B.,  25  years  old,  complains  of  headache  and  chronic  con- 
stipation. Eight  days  previously,  as  had  often  happened  before 
following  excitement,  she  had  an  attack  of  diarrhea,  which  after 
two  days  changed  to  constipation.  The  constipation  has  now  lasted 
for  six  days.  The  patient  feels  miserable,  suffers  from  nausea,  agi- 
tation, frequent  attacks  of  fear  and  violent  strangury.  The  patient 
declares  that  she  has  been  in  the  same  condition  several  times  before. 
The  examination  gives  us  a  relatively  scanty  result:  the  abdomen 
shows  slight  meteorism ;  no  sensitiveness  to  pressure,  no  rise  of 
temperature.  The  analysis  of  the  urine  is  negative.  The  patient 
never  had  any  spontaneous  pains,  no  vomiting.  The  internal  organs 
are  healthy.  The  lack  of  palatal  reflex  and  of  the  abdominal  reflex 
is  very  striking.  The  pharyngeal  reflex  is  weak,  the  conjunctival  re- 
flex normal.  The  anamnesis  gives  the  solution.  As  a  child  the 
patient  was  very  unruly  and  had  often  suffered  from  headache  and 
constipation.  When  she  was  fifteen  she  had  violent  attacks  of 
singultus.  The  patient  lisps.  The  father  died  of  diabetes,  one 
brother  was  an  enuretic  and  suffered  from  this  as  well  as  inconti- 
nence of  the  bowels  till  his  twelfth  year.  One  sister  was  unfortunate 


24  STUDY   OF   ORGAN    INFERIORITY 

in  her  marriage  and  at  times  has  attacks  of  coma.  From  the  anal- 
ysis of  this  case  we  would  like  to  emphasize  the  hereditary  organ 
inferiority  in  father,  brother  and  patient  and  the  distinct  indication 
of  the  early  history,  constipation  in  the  patient,  incontinence  of  the 
bowel  in  the  brother  as  well  as  lisping  in  talking,  which  according 
to  the  report  of  the  patient  was  particularly  evident  in  childhood. 
The  condition  of  the  patient,  who  accordingly  shows  a  startling  in- 
testinal inferiority,  belongs,  in  the  presentday  nomenclature  in  the 
realm  of  hysteria,  the  development  of  which  is  however  very  slight. 
In  the  sister  this  side  of  the  aspect  of  the  disease  seems  more  clearly 
developed. 

Richard  v.  R.,  a  healthy  man  of  30  years  of  age,  suffered  in  his 
fifth  and  sixth  years  from  violent  blinking.  Later  this  very  preva- 
lent defect  of  childhood  vanished  without  leaving  any  traces.  No 
eye  diseases  in  the  family.  One  brother,  Julius  v.  R.  is  a  well- 
known,  very  skilled  painter,  who  told  me  that  he  had  had  excep- 
tionally sensitive  eyes  as  a  child,  and  especially,  he  had  not  been  able 
to  stand  a  bright  light.  In  his  seventh  year  he  had  a  lengthy  attack 
of  lymphatic  conjunctivitis.  This  case  is  interesting  in  two  re- 
spects. It  shows  that  an  organ  inferiority  may  be  present  in  a 
family  without  any  particular  disease.  On  the  other  hand  we  find 
here  the  high  degree  of  development  of  the  inferior  organ  in  the  eye 
of  the  artist. 

Mrs.  Elsa  S.,  24  years  old,  suffered  till  late  in  her  childhood 
from  violent  blinking.  One  brother  of  this  woman  is  myopic  to  a 
very  high  degree,  the  father  towards  the  end  of  his  life  was  almost 
totally  blind.  Here  also  we  find  scattered  throughout  the  family,  in 
different  forms,  the  indications  of  inferiority. 

Alexandra  E.,  5  years  old,  is  being  treated  for  recurring  catarrhal 
conjunctivitis  and  blepharitis  squamosa.  For  two  years  there  has 
been  blepharospasm,  lasting  for  some  time  and  then  disappearing 
for  a  long  time,  appearing  at  intervals  which  have  no  time  relation 
to  the  state  of  irritation  of  the  eyes.  The  mother  had  been  operated 
on  as  a  child  for  convergent  strabismus,  and  has  astigmatism  on  both 
sides  and  a  slight  degree  of  myopia. 


CHAPTER  IV 
MORPHOLOGIC  INDICATIONS 

Our  consideration  of  the  inferiority  of  organs  places  the  begin- 
nings of  the  inferiority  in  the  period  of  embryonic  growth.  Thus 
the  significance  of  heredity  and  "  childish  faults  "  is  comprehensible 
in  the  widest  sense  of  the  word  and  their  connection  clear.  The  de- 
termination of  organic  disease,  heredity  and  childish  anomalies, 
makes  possible  a  proof  of  organ  inferiority  in  many  cases,  and 
in  other  cases  permits  one  at  least  to  express  a  suspicion.  A  further 
diagnostic  aid,  whose  significance  is  connected  with  that  of  the  other 
three,  lies  in  the  discovery  of  morphologic  arrest  of  development, 
malformation,  "signs  of  degeneration"  which  we  have  already 
designated  everywhere  as  morphologic  inferiorities. 

The  organ  inferiority  usually  enforces  itself  genetically  in  the 
individual  and  hinders  embryonic  or  functionally  related  parts  from 
fully  developing.  Usually  one  can  conclude  an  insufficiency  in  a 
second  or  third  organ  at  the  same  time,  which  seems  comprehensible 
since  the  cause  of  organ  inferiorities  can  be  referred  to  an  extended 
deficiency  of  formative  substance.  Pathology  reckons  with  degen- 
eration of  the  internal  organs  in  certain  cases.  Outside  of  these 
cases  of  disease  we  have  found  a  peripheral  expression  of  organ 
inferiority  in  childish  defects.  //  now  a  trace  of  this  embryonic 
check  comes  to  the  outer  portions  of  the  body  and  reveals  itself  in 
this  manner  to  the  investigator  this  happens  in  the  form  of  the  uni- 
versally known  signs  of  degeneration,  about  which  there  is  to-day 
a  great  number  of  observations  and  interpretations.  Their  value  is 
not  uniform.  As  far  as  I  can  see,  however,  the  conclusions  which 
follow  upon  the  nature  of  the  signs  of  degeneration,  are  entirely 
too  general  or  else  limit  themselves  to  emphasizing  the  degenerative 
tendency  of  the  whole  person,  the  inferiority  of  his  total  organism, 
above  all  his  psyche.  This  precipitancy  has  brought  a  great  deal 
of  discredit  to  the  theory  of  degeneration,  and  recently  people  have 
been  trying  to  prove  statistically  its  indefensibility,  in  this  form. 
To  prove  less  would  prove  more.  What  we  can  affirm  with  greater 
surety  in  regard  to  signs  of  degeneration,  is,  that  they  represent 
the  external  traces  of  the  organ  inferiority,  which  may  be  found 
in  a  similar  manner  in  the  whole  organ  or  in  single  parts  of 

25 


26'  STUDY   OF   ORGAN    INFERIORITY 

it.  If  we  add  besides  that  some  of  these  external  traces  may 
fail  in  spite  of  organ  inferiority,  that  the  degenerative  tendency 
may  extend  to  another  organ,  that  the  stigmata  of  inferiority 
may  belong  to  the  internal  organism  or  may  consist  of  decrease 
of  function,  and,  as  shall  be  pointed  out  later,  of  the  related  reflexes, 
we  can  consider  the  limits  of  a  "  degeneration  theory  "  as  known  to- 
day, as  sufficiently  outlined. 

The  significance  of  the  discoverable,  external  signs  of  degenera- 
tion is  undeniable  in  this  outline.  Their  relation  to  the  organ  in 
question  and  the  necessity  resulting  from  this  of  assuming  further 
signs  of  inferiority  in  the  whole  organ,  appears  to  be  sufficiently 
justified  and  will  be  illustrated  in  the  following  by  individual  ex- 
amples. The  probability  arises  that  in  such  cases  there  had  not 
been  enough  formative  material  to  finish  the  organic  development 
in  complete  harmony  and  with  sufficient  tectonic.  And  the  sus- 
picion can  quite  rightly  be  directed  on  the  central  portions  of  the 
organ,  and  one  can  ask  whether  the  deeper  or  related  parts  have 
remained  morphologically  or  functionally  backward,  in  which  case 
the  functional  deficiency  would  be  considered  in  general  the  low- 
est grade  of  primary  organic  check,  the  morphologic  hypoplasias 
or  aplasias  as  the  highest  degree.  The  injuries  growing  on  this 
weakened  ground  cannot,  to  be  sure,  be  graduated  in  a  like  manner, 
in  the  first  place,  because  functional  and  morphological  deficiencies 
may  combine  in  'different  degrees,  in  the  second  place,  because 
exogenous  disadvantages,  such  as  infection,  determine  in  a  marked 
degree  the  severity  of  the  disease.  To  this  is  added  the  fact,  to 
which  we  have  already  referred  several  times,  that  under  favorable 
external  circumstances,  or  as  a  result  of  compensation,  the  inferior- 
ity of  the  organ  may  be  hidden  or  even  overcome.  As  to  functional 
checks  we  must  expect  above  all,  in  addition  to  motor  weakness, 
scanty  development  and  failing  of  reflex  actions,  microreflexes,  and 
quantitative  as  well  as  qualitative  changes  in  glandular  secretions. 

The  frequent  report  of  external  signs  of  degeneration  in  appar- 
ently normal  people  shows  us  then  nothing  at  all  surprising  from  this 
point  of  view.  The  external  stigma  can,  we  think — by  itself — 
signify  a  unique  deficiency  in  the  development  of  the  organ.  But 
even  when  the  related  organs  participate  in  the  inferiority,  the  de- 
ficiency, in  so  far  as  it  is  compensated  to  a  lesser  degree  or  appears 
compensated  by  means  of  other  aids,  can  be  endured  fairly  well. 
Only  one  must  not  conclude  from  this,  as  individual  authors  some- 
times do,  that  one  should  deny  a  value  of  orientation  to  the  signs 
of  degeneration.  On  the  contrary!  The  physician  will  learn  to 


AND   ITS    PSYCHICAL    COMPENSATION  .  2J 

deduce  from  them  the  lesser  capability  of  resisting  of  the  hitherto 
still  functionally  capable  organs,  and  to  guard  against  sudden  in- 
juries. And  just  as  in  the  discussion  of  functional  inferiority  we 
must  emphasize  here  too,  how  often  organs  of  slight  inferiority 
may  develop  greater  functional  capacity  than  normal  organs.  The 
cause  lies  in  the  compulsion  of  a  constant  training  in  the  capacity 
for  adaptation  and  variability  often  adhering  to  inferior  organs  and 
surely  also  in  the  development  of  the  related  nervous  and  psychical 
complexes  heightened  by  inner  attention  and  mental  concentration 
upon  the  weaker  organ.  TKe  lasFnamed  compensatory  development 
of  the  nerve  track  comprises  also,  among  other  things,  the  develop- 
ment of  reflexes,  of  a  special  protective  arrangement  and  mobiliza- 
tion of  the  organ. 

This  is  not  the  place  to  give  an  extended  representation  of  signs 
of  degeneration  as  I  see  them,  as  peripheral  stigmata  of  organ  in- 
feriority. My  own  collection  of  illustrative  cases  would  be  too 
slight.  Literature  at  all  events  gives  us  sufficient  authority  for  this 
conception.  I  shall  only  refer  to  a  few  of  the  most  important 
stigmata  as  they  presented  themselves  to  me  in  connection  with 
organ  inferiority.  Congenital  or  hereditary  abnormal  development 
of  the  eyes,  the  eyelids,  pigmentary  anomalies  of  the  iris  (Fuchs), 
lamellar  cataract,  congenital  constriction  of  one  palpebral  fissure, 
myopia,  hypermetropia,  strabismus  are  often  found  in  people  who 
contract  other  affections  of  the  eye,  retinitis,  choroiditis,  detachment 
of  the  retina.  Functional  defects  are  often  accompanied  by  morpho- 
logic anomalies.  An  affection  in  one  eye  is  frequently  followed  by 
another  in  the  other  eye,  the  heredity  of  anomalies  of  the  visual  ap- 
paratus and  of  affections  of  the  eye  is  undoubted.  The  early  his- 
tory is  almost  always  faulty.  Very  striking  is  the  fact  that  so  many 
suckling  infants  show  strabismus  for  a  shorter  or  longer  time,  and 
some  time  after  birth.  It  would  not  be  surprising,  in  cases  of  strik- 
ing functional  or  artistic  capacity  of  the  eyes,  to  find  functional  or 
morphologic  anomalies  of  the  outer  eye  in  the  individual  or  in  his 
family. 

A  similar  thing  may  be  asserted  of  the  affections  of  the  audi- 
tory apparatus  in  connection  with  anomalies  of  the  outer  ear.  Here 
also  heredity  plays  a  notorious  part,  and  can  be  considered  a  cer- 
tainty, for  example  in  regard  to  deaf-mutism  and  otosclerosis.  At 
all  events,  from  my  point  of  view  only,  it  is  the  inheritance  of  an 
organ  inferiority  which  manifests  itself  in  different  forms  and  in 
different  places.  This  was  the  case  in  the  S.  family,  which  I  have 
had  under  observation,  in  which  three  of  the  children  suffered  from 


28  i  STUDY  OF  ORGAN  INFERIORITY 

otosclerosis  while  the  other  two  showed  marked  musical  ability. 
The  last  may  be  explained  by  the  oft-repeated  reference  to  the  over- 
compensation  in  an  inferior  organ.  One  of  the  brothers  had  a  fre- 
quently recurring  herpes  of  the  auricle,  which,  as  soon  as  I  saw  him, 
took  on  importance  as  an  indication  of  organ  inferiority  (of  the 
mouth,  nose,  urinary  or  sexual  organs).  Musicians  frequently 
suffer  from  ear  affections,  or  else  have  suffered  from  such  in  their 
childhood.  Beethoven  is  the  classic  example.  Mozart  is  supposed 
to  have  had  a  deformed  ear.  Veterinary  surgeons  have  abundant 
opportunity  to  prove  affections  of  the  ear  in  dogs  with  hanging  ears. 
In  a  like  manner  the  stigmata  of  the  nose,  hypertrophy  of  the 
mucous  membrane,  polypi,  adenoid  growths  and  the  anomalies  of 
the  mouth,  tongue,  teeth,  of  the  hard  and  soft  palate,  of  the  tonsils, 
are  connected  with  inferiorities  of  the  respiratory  apparatus  and 
the  inclination  to  disease  in  the  same.  Individual  authors  have, 
without  going  into  the  details  of  the  connection,  emphasized  this 
relation.  Perhaps  the  opinion  most  respected  is  that  in  which  is 
stressed  the  connection  between  the  anomalies  of  the  nose  and  bron- 
chial asthma,  and  between  adenoid  growths  or  hypertrophy  of  the 
tonsils  with  a  lesser  degree  of  development  of  the  thorax  and  the 
lungs.  I  do  not  need  to  explain  minutely  that  primarily  only  the 
condition  of  coordination  is  admitted;  but  later  when  the  function 
or  the  hygiene  of  deeper  lying  parts  of  the  breathing  organs  are 
encroached  upon  by  certain  conditions  of  growth,  the  peripheral 
stigmata  also  appear  to  be  etiologically  conditioned.  Deviations  of 
the  septum,  arrests  of  development  in  the  formation  of  the  mouth 
such  as  cleft  palate,  long  frenulum  linguae,  poor  teeth,  anomalies 
of  the  teeth,  inferior,  easily  bleeding  gums,  and  a  high  palate  are 
often  the  visible  expression  of  an  inferiority  in  the  respiratory  tract, 
which  does  not  always  of  course  appear  as  a  special  disease  form. 
Heredity  and  childish  anomalies  are  however  often  perceivable, 
among  the  latter  of  which  are  particularly,  stuttering,  sucking  of 
the  thumb,  sucking  the  lips  and  all  sorts  of  defects  of  speech.  Like- 
wise with  such  children  catarrh  of  the  air  passages,  false  croup  and 
sore  throats  are  often  found  as  Gutzmann  and  others  have  already 
pointed  out.  An  accumulation  of  these  peripheral  stigmata  is  not 
rare.  In  anticipation  I  must  say  that  the  palatal  reflex  also  very 
often  undergoes  changes  in  which  it  shows  itself  as  lacking,  very 
weak,  or  increased,  whereas  the  pharyngeal  reflex  according  to  my 
examinations  shows  this  connection  more  rarely.  In  a  like  manner 
these  stigmata  are  found  very  noticeably  in  neuroses,  with  singers, 
speakers,  and  in  connection  with  severe  diseases  of  the  respiratory 


AND   ITS    PSYCHICAL    COMPENSATION  .    2Q 

tract,  be  it  in  the  patient  examined  or  among  his  relatives,  and  along 
this  line  I  might  especially  emphasize  pulmonary  tuberculosis. 

Miss  L.  shows  on  her  upper  lip,  in  the  position  of  the  left  em- 
bryonic palatal  cleft,  a  small  ridge-shaped  thickening  which  seems 
to  be  colored  bluish  by  dilated  blood  vessels.  The  ridge  is  congen- 
ital. The  anamnesis  tells  us  that  the  young  lady  often  suffers  from 
laryngeal  catarrh  and  bronchitis,  whereas  the  father,  mother,  and 
one  brother  died  of  pulmonary  tuberculosis.  Palatal  reflex  lacking. 
The  patient  shows  slight  neuropathic  characteristics,  which  have  to 
do  with  the  digestive  tract,  and  often  suffers  from  palpitation  of 
the  heart,  sleeplessness  and  lack  of  appetite.  She  is  an  excellent 
singer  (soprano).  One  sister  has  attacks  of  anxiety  and  at  42 
years  of  age  still  shows  a  defect  in  speech  in  the  form  of  lisping. 
In  regard  to  this  case  I  should  only  like  to  emphasize  that  to  me 
the  impression  of  the  connection  between  a  beautiful  singing  voice 
and  the  organ  inferiority  which  I  have  outlined  is  a  definite  one,  and 
that  I  have  considerable  material  to  support  it. 

Marie  B.,  12  years  old,  came  under  medical  supervision  on  ac- 
count of  stuttering  and  lisping.  Her  father  died  of  pulmonary 
tuberculosis.  As  a  child  the  brother  stuttered  also,  and  was  at  that 
time  being  treated  for  cervical  vetebral  caries.  Mother  apparently 
healthy.  The  patient  shows  strikingly  poor  teeth,  hypertrophy  of 
the  mucous  membrane  of  the  nose  and  adenoids.  Progress  at 
school  poor.  Palatal  reflex  deficient  in  the  patient  and  her  brother. 

Josef  S.,  50  years  old,  suffers  from  follicular  tonsillitis  which 
frequently  recurs.  Since  his  fifth  year,  the  patient  has  had  numerous 
attacks  of  bronchial  asthma,  against  which  he  has  hitherto  fought 
in  vain.  Polypi  of  the  mucous  membrane  in  the  nose,  adenoids  and 
hypertrophic  tonsils  had  been  removed  by  operation.  Of  the  other 
stigmata  only  prognathism  was  found.  In  his  seventh  year  the 
patient  had  pneumonia  and  costal  pleurisy.  The  thorax  of  this 
strikingly  large  man  is  narrow  and  only  slightly  arched.  At  the 
height  of  the  posterior,  left-hand  end  of  the  lung  there  is  an  angioma 
as  big  as  a  hemp  seed.  The  patient's  father  had  suffered  from  nasal 
polypus  and  once  had  pneumonia.  A  brother  who  also  showed 
prognathism  died  of  pneumonia.  The  patient's  twelve-year-old 
daughter  recently  had  pneumonia  and  costal  pleurisy,  a  son  had  to 
be  tracheotomized  in  the  course  of  an  attack  of  diphtheria,  a  second 
son  was  operated  on  a  short  while  ago  for  hypertrophy  of  the 
tonsils.  The  analysis  of  this  case  accordingly  shows  as  a  founda- 
tion for  asthma,  a  very  well  substantiated  hereditary  inferiority 
of  the  respiratory  apparatus,  which  also  expresses  itself  peripherally 


3O  STUDY  OF  ORGAN  INFERIORITY 

in  individual  members  of  the  family  in  the  appearance  of  congenital 
stigmata.  I  should  like  also  to  add  briefly  that  just  as  in  the  case 
of  nevus  a  well-deserved  place  should  be  accorded  to  telangiectasis 
and  angiomas  in  the  ensemble  of  organ  inferiority.  Years  ago  some 
one  declared  that  there  was  a  connection  between  angiomas  of  the 
skin  and  carcinomas  of  the  internal  organs.  The  connection  is  this, 
namely,  that  an  organ  inferiority  is  the  basis  of  them  both.  The 
author  in  question  went  too  far.  The  complete  denial  however  with 
which  his  statements  were  met  seems  unjustifiable  to  us.  The  posi- 
tion of  the  nevi,  telangiectasis,  angiomas,  in  short  all  the  congenital 
skn  anomalies  in  the  question  of  inferiority  will  be  touched  upon 
again  at  the  end  of  this  chapter. 

In  the  above  I  have  tried  to  picture  the  connection  between  the 
stigmata  of  the  mouth  and  the  inferiority  of  the  respiratory  appara- 
tus. But  there  is  no  doubt  that  they  are  in  just  as  close  connection 
with  the  inferiority  of  the  digestive  apparatus ;  the  common  periph- 
eral orifice  of  two  organs  will  preserve  the  power  of  one  of  the  two, 
or  of  both.  My  experience  now  leads  me  to  think  that  all  these 
stigmata  of  the  oral  portions  may  often  serve  as  clues  for  the  dis- 
covery of  inferiorities  of  individual  components  of  the  gastro- 
intestinal apparatus,  just  as  is  frequently  found  in  diseases  of  re- 
lated sections  of  organs.  This  study  of  the  matter  cannot  give  a 
complete  picture  of  the  relation.  It  must  however  be  pointed  out 
that  diseases  such  as  appendicitis,  diabetes,  obesity,  alcoholism,  ulcus 
rotundum,  diseases  of  the  liver,  according  to  my  experience  belong 
in  this  outline,  and  that  the  same  argument  must  hold  for  carclno- 
mata  and  tumors  of  the  nutritive  tract.  A  few  of  these  connections 
have  already  become  truisms  in  medicine,  even  if  their  significance, 
in  my  opinion,  is  incomplete  and  must  first  be  borrowed  from  the 
inferiority  theory.  The  same  is  true  of  the  connection  between 
bad  teeth  and  gastro-intestinal  disturbances,  as  the  relation  between 
angina  and  appendicitis,  recently  stressed  by  Kretz,  which  we  regard 
as  diseases  coordinated  in  one  inferior  organ.  A  coated  tongue  like- 
wise has  significance  in  gastro-intestinal  affections. 

Hernias  and  stigmata  which  are  grouped  about  the  anus,  such 
as  hemorrhoids,  fissures,  prolapse,  have  the  same  significance,  the 
connection  of  which  with  organ  inferiority  may  often  be  proved 
in  oral  stigmas,  childish  defects,  reflex  anomalies,  and  neuroses  in 
the  family,  the  connection  of  which  with  diseases  in  the  stigmatized 
organ  often  may  be  recognized  in  the  family,  at  least,  in  the  above 
mentioned  manner. 

Albert  F.,  32  years  old,  singer  of  comic  opera  songs,  acquired 


AND   ITS    PSYCHICAL    COMPENSATION  m    31 

lues  four  years  ago  and  since  then  has  been  troubled  by  hypochon- 
driacal  moods.  His  father  suffered  for  many  years  from  gall- 
stone colic,  his  mother  died  of  carcinoma  of  the  stomach.  The 
patient  had  always  been  well  before  and  once  only  was  in  the  care 
of  a  specialist  on  account  of  a  "  singer's  nodule."  At  present  there 
is  a  herpes  on  the  upper  lip,  which,  as  the  patient  says,  often  recurs. 
Palatal  reflex  lacking,  pharyngeal  reflex  diminished.  All  the  pa- 
tient's incisor  teeth  are  crooked,  two  upper  incisors  lacking.  These 
tooth  anomalies  must  be  considered  as  external  signs  of  degenera- 
tion, corresponding  to  an  inferiority  of  the  digestive  tract  in  the 
family;  father  and  mother  suffered  from  severe  diseases  of  this 
apparatus.  The  significance  of  the  herpes  has  already  been  touched 
upon,  the  pharyngeal  reflex  anomalies  point  to  the  similar  inferi- 
ority of  the  respiratory  apparatus,  to  which  is  added  as  further  evi- 
dence of  inferiority,  singer's  nodule  and  deficient  palatal  reflex. 
The  patient's  profession  leads  us  to  the  same  conclusion.  We  must 
regard  the  "  singer's  nodule  "  as  analogous  to  many  other  anomalies 
in  its  role  as  stigma,  which  betrays  to  us  the  inferior  organ,  the 
same  organ  which  forces  its  possessor  into  the  profession  of  a 
singer  or  speaker. 

The  following  case  seems  typical  to  me :  Ignas  C.,  a  merchant 
50  years  old,  has  for  many  years  suffered  from  obstinate  constipa- 
tion. He  belongs  to  a  corpulent  family  in  which,  as  it  happens, 
constipation  is  not  predominant.  Ever  since  his  youth  the  patient 
has  been  bothered  by  anal  fissures,  which  have  hitherto  defied  all 
conservative  treatment.  One  son  showed  epignathy  and  died  when 
he  was  fifteen  in  diabetic  coma.  The  childhood  anamnesis  of  the  son 
showed  incontinentia  alvi  up  to  his  fifth  year  and  lisping  as  a  defect 
in  speech.  In  the  father  there  is  deficient  palatal  reflex,  the  same 
in  the  daughter,  who  is  ill  with  severe  hysteria  and  who  shows  a 
shortening  of  the  upper  lip.  In  this  case  we  find  in  addition  to 
oral  stigmas  in  the  son  and  daughter,  with  which  this  chapter  deals, 
connections,  which  are  mentioned  quite  often  in  works  on  this  sub- 
ject, but  which  have  not  been  explained.  We  mean  the  relation  of 
diabetes  to  obesity,  to  neurosis  and  to  dental  defects.  An  inferiority 
of  the  nutritive  apparatus  may  lie  at  the  bottom  of  all  three,  which 
I  have  often  proved  to  my  own  satisfaction,  and  which  in  the  first 
case  compensates  within  itself,  and  appears  to  be  overcompensated, 
and  in  the  second  case  (of  which  more  later)  involves  the  related 
nerve  track  and  manifests  itself  undisguised  only  in  the  third  case. 
The  deficient  palatal  reflex  found  with  it  suggests  to  us  an  inexact 
development  of  the  related  reflex  apparatus,  a  check  which  can  be 
further  indicated  in  diabetes  by  a  deficiency  in  the  patellar  reflex. 


32  STUDY  OF  ORGAN  INFERIORITY 

The  peripheral  stigmata  do  not  have  to  be  of  a  particular  sort 
at  all.  Any  other  conclusion  but  that  of  inferiority  of  the  nutritive 
tract  is,  as  has  already  been  emphasized,  inadmissible,  and  complete 
knowledge  can  only  be  won  from  the  great  number  of  symptoms  of 
inferiority,  which  in  general  is  not  so  very  difficult.  The  following 
case  is  an  example. 

Kdthe  H.}  24  years  old,  lost  almost  all  the  teeth  in  her  upper  jaw 
five  years  ago,  and  now  uses  a  set  of  false  teeth.  The  patient  has 
come  under  our  care  on  account  of  loss  of  appetite,  which  has 
already  lasted  for  6  months.  There  are  neither  spontaneous  pains 
nor  sensibility  to  pressure.  During  the  six  month  period  of  want 
of  appetite,  vomiting  has  occurred  three  times,  and  this  also  without 
pain  preceding.  The  patient  says  that  once,  four  years  ago,  she 
vomited  blood.  As  a  child  she  suffered  with  frequent  vomiting  and 
at  times  would  faint  from  nausea.  The  present  sickness  is  supposed 
to  be  related  to  violent  excitement.  The  report  on  the  internal  or- 
gans was  negative.  From  the  symptomatology  of  this  want  of  ap- 
petite we  must  still  emphasize  a  particular  distaste  for  meat.  The 
emaciation  during  the  sickness  is  given  as  a  loss  of  weight  of  about 
6  Ibs.  Palatal  and  pharyngeal  reflexes  were  heightened.  The  case 
had  the  appearance  of  a  gastro-neurosis,  and  ran  along  with  slight 
improvement  till  suddenly,  two  months  later,  intestinal  colic,  violent 
vomiting,  and  intense  sensibility  to  pressure  in  the  region  of  the 
appendix  set  in  with  fever.  After  the  diseased  appendix  was  re- 
moved by  operation,  there  was  complete  recovery.  Now  there  is 
vomiting  only  at  times  and  in  conjunction  with  migraine. 

The  analysis  again  shows  us  the  peripheral  findings,  reflex  anom- 
alies of  the  palate,  such  as  I  have  occasionally  found  in  ulcus 
rotundum  and  appendicitis — usually  heightening,  rarely  deficiency, 
in  the  palatal  reflexes,  the  anamnesis  reaching  into  early  childhood 
and — a  fact  which  explains  the  relative  rarity  of  the  case — disease 
in  different  parts,  in  the  teeth,  the  stomach,  the  appendix.  In  the 
literature  we  find  references  to  gastric  hemorrhages  in  appendicitis, 
which,  as  in  the  above  case,  in  which  the  periods  of  sickness  were 
separated,  we  must  lead  back  to  the  unity  of  a  gastro-intestinal  in- 
feriority. But  the  connection  of  neurosis  also  with  appendicitis 
makes  this  case  remarkable.  The  anamnesis  at  least  portrays  child- 
ish hysteria  and  the  loss  of  appetite  preceding  the  appendicitis  looks 
like  a  neurosis.  The  distaste  for  meat  is  very  striking,  a  sort  of 
psychical  defence  of  the  inferior  organ,  which  we  also  recognize 
from  the  symptomatology  of  carcinoma  of  the  stomach,  another 
disease  on  the  organ  inferiority  basis.  Here  I  should  like  to  em- 


AND   ITS   PSYCHICAL   COMPENSATION  .    33 

phasize  the  fact  that  this  psychical  defence  arises  from  a  compensa- 
tion in  the  central  nervous  system,  which  may  be  put  on  a  level  with 
the  increased  palatal  reflex. 

In  general  the  dental  formation  and  its  deficiency  is  an  im- 
portant index  of  the  inferiority  of  the  nutritive  tract.  Even  in 
rachitic  children  the  coincidence  of  poor  or  late  dentition  and  gastro- 
intestinal disturbances  is  a  fact,  the  pursuit  of  which  promises  in- 
teresting results.  In  connection  with  this  I  shall  only  mention  the 
frequently  occurring  obesity,  which  seems  to  me  to  be  a  result  of 
the  over-compensation  of  the  inferior  stomach,  intestine  and  its  de- 
pendencies, and  not  only  in  rachitic  children  but  in  grown-ups  as 
well.  I  have  repeatedly  found  in  higher  degrees  of  adiposity  all  the 
indications  such  as  I  should  expect  in  intestinal  inferiority  or  at 
least  various  signs  of  it.  The  same  is  true  in  heredity  and  in  the 
corresponding  stigmas  in  heredity,  or  diseases,  which  had  occurred 
in  the  gastro-intestinal  tract.  Likewise  constipation  or  involuntary 
evacuation  of  the  bowels  in  early  childhood.  In  my  small  collec- 
tion of  cases  illustrative  of  diabetes  there  is  a  great  deal  of  material 
touching  this,  for  the  connection  between  diabetes  and  obesity  is 
well  known  on  all  sides.  Furthermore  one  can  also  frequently  find 
palatal  reflex  anomalies  which  I  shall  discuss  later. 

The  following  case  shows  many  of  the  connections  of  which  I 
have  spoken: 

Friederike  U.,  6  years  old,  a  child  of  healthy  parents — father  is 
obese  and  belongs  to  a  family  inclined  to  adiposity — fell  ill  while 
out  in  the  country  with  often  recurring  diarrhea,  accompanied  by 
violent  pain.  In  her  second  year  the  patient  had  had  a  long  drawn 
out  attack  of  intestinal  catarrh.  She  was  being  treated  by  a  dentist 
for  prognathism  which  only  appeared  in  the  family  in  one  other  case, 
in  the  eldest,  her  eleven-year-old  sister,  when  again,  with  colic,  the 
intestinal  affection  now  under  discussion  revealed  itself  as  appen- 
dicitis, which  the  operation  proved  to  exist.  Two  years  ago  she 
had  an  operation  for  adenoids  and  still  speaks  nasally  and  with  a 
thick  tongue.  The  palatal  reflex  in  this  child  as  well  as  in  both 
her  sisters  was  excessively  increased.  Later  on  I  learned  that  the 
father,  who  had  always  been  a  healthy  man,  had  suffered  until 
puberty  from  nocturnal  enuresis  and  involuntary  defecation  just  as 
had  several  of  his  now  very  corpulent  brothers  and  sisters.  The 
patient's  older  sister  had  suffered  from  earliest  childhood  from  con- 
stipation and  promptly  shows  loss  of  appetite  after  excitement  at 
home  or  at  school.  She  is  a  nervous  child  and  frequently  suffers 
from  headache,  and  at  times  complains  of  colic,  without  causing  a 


34  STUDY  OF  ORGAN  INFERIORITY 

suspicion  of  appendicitis  to  be  justified.  Anal  fissures  and  sciatic 
pains  often  occur  and  vanish  after  a  short  time.  The  second  sister 
is  healthy. 

The  analysis  of  this  case  is  simple  after  what  I  have  said.  I 
must  add  though,  how  closely  related  appendicitis  and  the  so-called 
pseudo-appendicitis  are,  a  fact  which  I  can  prove  from  other  cases. 
It  is  the  same  relation  as  that  existing  between  neuroses  of  the 
stomach  and,  say,  ulcus  ventriculi.  Both  are  at  times  found  in  one 
family,  and  can  even  pass  into  each  other  in  individual  cases.  The 
proof  of  the  inferior  ground  is  however  always  found  in  the  way 
I  have  suggested. 

At  the  close  of  the  chapter  I  must  mention  a  phenomenon  which 
apparently  does  not  fit  into  the  scheme  hitherto  outlined.  For  my 
assumption  is  to  establish  the  meaning  of  external  stigmata  as 
signs  of  the  inferiority  of  the  related  organ.  Now  there  are  a 
great  number  of  external  stigmata  in  which  perhaps  the  acceptance 
of  an  inferiority  of  the  organ  to  which  they  belong,  the  skin,  might 
be  proved  but  which,  however,  unquestionably  show  a  closer  rela- 
tion to  their  segmentally  related  internal  organs,  so  that  their  pres- 
ence shows  an  inferiority  of  the  segment,  a  "  segmental  insuffi- 
ciency." 

I  have  often  referred  to  them  in  the  previous  pages.  As  far  as 
I  can  lay  stress  on  their  part,  it  is  a  question  of  nevi  of  all  sorts,  of 
angiomas  of  the  skin,  of  externally  visible  telangiectasis  and  of 
neurofibromas.  Their  hereditary  occurrence  can  scarcely  be  doubted. 
The  significance  of  an  occasional  transformation  of  a  nevus  to  a 
carcinoma  has  already  been  emphasized  in  my  remarks  on  the 
causation  of  carcinomata  on  the  basis  of  the  inferiority  theory.1 
Furthermore  I  must  introduce  Virchow's  discussions  of  the  fissural 
angioma  as  fetal  arrest  of  development  and  perceive  in  them  a  stage 
in  my  conception  of  the  indications  of  segmental  inferiority.  One 
can  find  an  abundance  of  material  in  the  literature  which  may  be  in- 
terpreted according  to  my  views.  I  must  however  put  off  this  fasci- 
nating task  for  some  later  time.  I  can  not  dwell  upon  the  theories 
of  Head  either,  the  connection  of  which  with  the  conception  under 
discussion  becomes  clear  at  once  if  one  accepts  with  me  segmental 
disease,  for  which  the  ground  is  prepared  by  segmental  inferiority. 

I  shall  now  introduce  a  few  striking  facts  which  one  can  very 
often  find  in  following  carefully  the  ideas  which  I  have  sketched 
here.  I  must  emphasize  first  of  all  that  nevi  in  pulmonary  tuber- 

1  As  I  learn  from  a  report  at  the  time  of  writing  my  study,  it  seems  that 
my  conception  of  carcinoma  is  very  like  that  of  Borst  ( Wurzburger  Abhand- 
lungen). 


AND   ITS    PSYCHICAL    COMPENSATION  -      35 

culosis,  in  the  patient  or  his  family,  are  uncommonly  frequent.  They 
are  situated  in  the  most  varied  places  on  the  thorax,  on  the  healthy 
side,  on  the  diseased  side,  and  are  frequently  as  high  up  as  the  zone 
of  the  disease  or  even  somewhat  higher.  One  often  finds  cases  like 
the  following: 

Wladimir  T.,  23  years  old,  a  student,  has  complained  for  two 
months  of  a  cough  and  pressure  in  his  chest,  perspires  a  great  deal 
at  night  and  declares  that  he  has  grown  very  thin.  The  thorax  is 
only  slightly  arched,  greatest  circumference  in  this  man  of  medium 
size  is  82  cm.  Pulmonary  sound  RHO  somewhat  retracted.  Aus- 
cultation shows  RHO  to  RHM  soft  vesicular  rattling  in  inspiration, 
and  the  same,  only  not  as  loud,  inward  from  the  right  shoulder 
blade.  Teeth  sound,  palate  rather  highly  arched,  palatal  reflex  very 
much  heightened.  If  the  soft  palate  is  touched,  the  uvula  disap- 
pears without  causing  any  particular  inclination  to  vomit.  Over 
the  middle  of  the  right  shoulder  blade  there  is  a  nevus  pigmentosus 
and  it  is  just  about  in  the  projection  of  the  lower  rim  of  the  per- 
ceivable center  of  disease.  The  patient's  mother  as  a  girl  of  18  suf- 
fered from  catarrh  of  the  apex  of  the  lung  and  was  finally  cured 
after  a  long  climatic  treatment.  She  is  now  forty-three  years  of 
age  and  has  always  been  well  since  then.  One  of  the  patient's 
brothers  is  now  in  a  hospital  at  Davos  for  catarrh  of  the  apex  of  the 
lung  on  the  right  side. 

Johann  K.,  25  years  old,  a  student,  had  spitting  of  blood  6  years 
ago.  A  little  while  ago  he  fell  ill  of  dry,  left-sided  pleuritis.  Palatal 
reflex  heightened.  In  the  thorax  in  back  and  in  front  there  were 
scattered  naevi.  This  is  a  very  frequent  condition. 

Hans  S.,  5  years  old,  is  being  treated  for  intestinal  auto-intoxi- 
cation. Close  up  under  Poupart's  ligament  there  is  a  nevus  the  size 
of  a  grain  of  hemp.  In  the  same  place  on  the  right  his  father  who 
was  once  an  enuretic  has  a  testicle  which  did  not  descend  normally. 

I  have  already  referred  in  the  remarks  on  the  carcinoma  theory 
to  the  case  of  Nadja  J. — nevus  on  the  right  above  the  level  of  the 
nostril,  and  whose  mother  suffered  from  carcinoma  of  the  upper 
jaw  on  the  left  side. 

David  K.,  82  years  old,  before  only  suffered  from  constipation 
(intestinal  inferiority)  and  occasional  attacks  of  colic  in  the  region 
of  the  gall-bladder.  For  a  year  there  has  been  a  high  degree  of 
emaciation  and  loss  of  appetite.  After  repeated  tests  the  palatal 
and  pharyngeal  reflexes  were  found  to  be  wanting.  In  the  region 
of  the  gall-bladder  one  can  feel  a  roundish  hard  tumor  about  the 
size  of  a  walnut.  The  liver  is  enlarged,  a  rough  structure  and  pain- 


36  STUDY  OF  ORGAN  INFERIORITY 

ful  upon  pressure.  There  is  5  per  cent,  sugar,  no  acetone,  no 
diacetic  acid  in  the  urine,  the  quantity  of  which  has  increased.  Som- 
nolence after  a  few  days,  from  which  the  patient  again  recovered, 
then  increasing  jaundice  and  after  a  month  death.  Diagnosis:  car- 
cinoma of  the  gall-bladder.  A  little  beneath  and  to  the  side  from 
the  tumor  is  a  nevus  pigmentosus  as  big  as  a  lentil  and  a  small  skin 
hemangioma.  Two  of  the  patient's  daughters  show  the  above  men- 
tioned stigmata  of  organ  inferiority,  epignathism  and  faulty  posi- 
tion of  the  upper  incisor  teeth  and  are  burdened  with  defects  of 
speech.  Similar  conditions  are  not  found  in  the  parents. 

It  would  be  easy  to  prove  that  the  diseases  of  the  thyroid  gland 
also  originate  in  the  form  of  an  inferiority.  We  give  the  follow- 
ing case  because  of  its  relation  to  segmental  inferiority. 

Mrs.  Rosalie  G.,  46  years  old,  has  had  since  her  youth  a  cystic 
struma  of  the  size  of  a  walnut  on  the  right  side  which  has  been 
punctured  several  times.  On  the  right  in  the  throat  and  neck  there 
are  numerous  pigmented  nevi,  only  a  few  on  the  left.  The  patient, 
who  complains  of  long-standing  hoarseness  and  frequent  coughs,- 
shows  greatly  heightened  palatal  reflex.  General  adiposity. 

Josef  Sch.,  a  broker,  55  years  old,  complains  of  constipation 
and  bleeding  from  hemorrhoids.  Complete  absence  of  teeth  since 
his  twenty-fifth  year.  At  the  left  above  the  open  inguinal  ring 
there  is  a  pigmented  nevus.  No  hernia.  His  son,  Paul,  19  years 
old,  has  a  defect  in  speech,  and  suffers  from  left-sided  inguinal 
hernia. 

Albert  K.,  a  private,  42  years  old,  complains  of  attacks  of  violent 
pains  in  the  region  of  the  heart,  "  as  though  something  were  being 
distended,"  pains  which  radiate  into  the  left  shoulder  joint  and  into 
the  left  arm.  The  patient  had  always  been  healthy.  Syphilis  is 
denied,  mild  drinking  admitted.  The  patient's  father  was  a  healthy 
man  till  an  advanced  age,  the  mother  died  at  thirty-one  of  pericar- 
ditis. Diagnosis:  angina  pectoris  as  a  result  of  arteriosclerosis. 
On  the  level  of  the  apex  of  the  heart  there  are  numerous  telangiec- 
tases,  which  encircle  the  front  left  side  of  the  thorax  like  a  ribbon. 
On  the  back,  at  the  height  of  the  angulus  scapulae,  on  the  left  and 
the  right  there  are  several  nevi. 

Anton  E.,  a  mechanic,  48  years  old,  had  always  been  well.  His 
father,  a  well-known  physician,  died  at  62  of  a  gastric  hemorrhage. 
In  the  region  of  the  stomach,  about  a  finger's  breadth  beneath  the 
edge  of  the  thorax,  there  is  an  angioma  as  big  as  a  grain  of  hemp, 
and  at  the  same  level  to  the  right  there  are  two  smaller  angiomata. 

Wolfgang  St.,  manufacturer,  56  years  old,  is  suffering  from  be- 


AND   ITS    PSYCHICAL    COMPENSATION  37 

ginning  arteriosclerosis.  In  the  thirties  he  lost  most  of  the  teeth 
in  his  upper  jaw,  and  has  worn  a  false  set  since  then.  Palatal 
reflex  in  the  patient  as  well  as  in  his  two  sons  is  greatly  heightened. 
Patient's  father  died  of  pneumonia,  his  mother  of  carcinoma  of  the 
stomach.  Just  under  the  edge  of  the  thorax  about  on  a  vertical  line 
through  the  left  nipple  there  is  pigmented  nevus  as  big  as  a  pea. 
On  the  left  half  of  the  back  there  are  two  little  neurofibromata, 
the  larger  about  the  size  of  a  pea,  a  finger's  breadth  under  the  angle 
of  the  scapula,  the  smaller  one  under  the  scapular  spine.  After 
our  discussion  the  idea  seems  justified  that  of  the  two  neurofibro- 
mata the  lower  one  is  an  inheritance  from  the  mother,  the  upper 
one  from  the  father. 

Whoever  knew  the  composer  Bruckner  will  remember  that  he 
had  a  nevus  under  the  zygomatic  arch  at  the  height  of  the  lobule 
of  the  ear.  In  this  case  I  might  also  discover  an  expression  of 
the  inferiority  of  hearing,  which  has  developed  in  segmental  ar- 
rangement. Bruckner  as  well  as  apparently  all  great  composers  has 
attained  such  a  remarkable  artistic  height  in  striving  to  conquer  the 
auditory  inferiority  and  transforming  it  into  inventive,  creative 
hearing. 

Before  we  close  this  chapter,  we  wish  in  a  certain  degree  to 
make  the  connection  with  the  results  of  pathology  already  at  hand. 
As  I  have  already  pointed  out  several  times  Schick  and  Sorgo  have 
indicated  the  connection  between  certain  definite  modifications  of 
mammary  glands  and  pulmonary  tuberculosis.  This  condition  as 
well  as  Frankel's  emphasis  on  the  narrowness  of  the  chest  and 
Rothschild's  on  the  angle  of  the  sternum  in  pulmonary  tuberculosis 
seem  to  me,  even  if  not  as  distinct  as  my  reports,  to  be  founded 
on  the  character  of  segmental  inferiority.  Only  in  these  cases 
a  segment,  not  yet  diseased,  may  declare  its  inferiority,  where- 
as the  disease  is  localized  in  an  adjoining,  or  nearby  segment.  I 
myself  have  seen  one-sided  or  two-sided  diminution  of  the  areola, 
but  also  have  seen  retraction  of  the  mamillae  in  women  who  have 
had  to  stop  nursing  because  of  lack  of  milk.  I  have  also  seen  lack 
of  milk  when  the  areola  was  hairy  (in  the  case  of  Mrs.  Lina  T., 
whose  mother  died  of  carcinoma  of  the  nipple). 


CHAPTER  V 
REFLEX  ANOMALIES  AS  INDICATIONS  OF  INFERIORITY 

We  have  already  often  emphasized  the  fact  that  inferiority  does 
not  make  itself  felt  under  all  conditions.  I  should  like  to  add  be- 
sides that  the  determination  of  a  deficiency  becomes  possible,  and 
attracts  our  attention,  only  when  the  inferiority  conies  into  promi- 
nence in  some  shortcoming  of  a  function,  in  a  failure  in  execution. 
For  it  is  at  this  point  first,  whether  during  good  health  or  in 
the  course  of  disease,  that  it  becomes  perceptible  and  forces  us  to  a 
consideration  of  the  circumstances.  Whatever  we  can  expect  from 
the  nature  of  the  matter,  from  defect  phenomena,  will  appear  as 
motor  insufficiency,  as  deficient  production  of  related  glandular 
secretions  and  above  all,  as  more  inadequate  development  or  lack 
of  reflex  actions  of  all  sorts,  but  also  as  the  opposite  of  this,  such 
things  as  motor  over-activity,  as  hypersecretion  and  as  increase 
in  the  reflexes. 

Virchow's  hypoplasia  of  the  vascular  system  might  be  consid- 
ered as  a  prize  case  of  motor  weakness.  We  meet  with  deficient 
production,  for  example,  in  certain  diseases  of  the  thyroid  gland  or 
in  chlorosis  (Kahane).  We  wish  to  direct  our  attention  at  this 
point  particularly  to  the  deficiency  and  the  exaggeration  of  reflexes, 
particularly  the  reflexes  of  the  mucous  membranes,  because  there  is 
a  certain  amount  of  material  available  for  this,  and  its  coincidence 
with  other  tokens  of  inferiority  seems  warranted  to  me.  Thus  it 
happens  that  the  state  of  these  anomalies  of  reflexes  is  wonderfully 
fitted  to  disclose  an  organ  inferiority. 

The  following  investigation  by  no  means  extends  to  the  great 
number  of  well-known  skin  and  mucous  membrane  reflexes.  I  had 
to  be  satisfied  with  putting  only  a  minority  through  a  systematic 
examination,  and  of  these  shall  emphasize  only  the  palatal  and  con- 
junctival  reflexes.  First  however  we  must  touch  upon  a  class  of 
reflexes  whose  presence  escapes  immediate  recognition  but  can 
scarcely  be  denied.  There  is  no  doubt,  that  in  the  inner  part  of 
the  organs,  particularly  from  the  tubular  formation  of  the  mucous 
membrane  out,  reflex  actions  might  perhaps  be  incited  at  every 
point,  and  by  all  sorts  of  stimulation,  reflex  actions  which  are  of 
the  utmost  importance  for  the  continuation  of  secretion  and  excre- 

38 


STUDY  OF  ORGAN  INFERIORITY  39 

tion.  //  I  may  draw  conclusions  from  the  analogy  with  the  phe- 
nomena to  be  mentioned  later,  it  seems  certain  to  me  that  certain 
diseases,  such  as,  for  example,  cholelithiasis,  nephrolithiasis,  cylin- 
druria,  Curschmann's  spirals,  are  connected  with  a  decreased  reflex 
capacity  in  the  related  part  of  the  organ,  without  perhaps  being  ex- 
clusively determined  by  it. 

The  lack  of  palatal  and  conjunctival  reflexes  is  an  occurrence  well- 
known  to  all  but  which  has  hitherto  played  a  small  role  in  medicine. 
Still  less  frequently  observation  found  increase  in  these  reflexes. 
The  universally  conventional  view,  which  is  connected  with  such 
cases  particularly  with  weakening,  consists  mostly  in  the  reference 
to  its  relation  to  hysteria,  which  is  in  turn  questioned  on  other 
sides.  If,  for  simplicity's  sake,  we  waive  organic  nerve  affections, 
/  must  make  the  declaration  that  the  lack  as  well  as  the  striking 
strengthening  of  these  reflexes  should  be  considered  as  attributes 
of  organ  inferiority. 

I  offer  the  following  as  proof:  (i)  These  reflex  anomalies  are 
found  very  frequently  in  heredity,  or  else  occur,  where  diseases  of 
the  related  organ  can  be  proved  in  the  heredity;  (2)  they  stand 
in  the  same  relation  to  childish  defects  as  stigmata;  (3)  they  are 
found  in  connection  with  stigmata  of  the  oral  region  or  when  such 
stigmata  occur  in  the  heredity;  (4)  they  are  found  in  connection 
with  diseases  of  the  related  organs  or  when  such  diseases  exist 
in  the  family. 

Before  we  take  into  consideration  the  proofs  and  references 
from  the  list  of  illustrative  cases,  we  must  bring  in  a  few  details 
which  deserve  attention  in  later  examinations.  Thus  with  regard 
to  the  testing  of  the  reflexes.  Authors  leave  no  doubt  as  to  the 
connection  between  reflex  activity  and  the  psyche.  A  few  things 
should  be  added  here.  If.  for  example,  one  makes  a  test  of  the 
palatal  reflexes  one  can  easily  find  that  the  results  vary  according 
as  the  patient  is  influenced  by  the  test.  Thus  it  can  happen  that  a 
second  examination  by  means  of  touching  the  palate  at  the  height 
of  the  insertion  of  the  uvula  results  in  a  greater  reaction — the 
sense  of  a  choking  reflex — or  a  smaller  one.  In  the  first  case  we 
must  suppose  that  through  the  initial  unsuspected  tests  which  were 
made  a  feeling  of  nausea  arose  in  the  patient  which  on  second 
touching  was  ready  to  manifest  itself.  It  is  clear  that  in  this 
case  we  no  longer  have  to  do  with  the  normally  present  reflex 
activity  in  the  soft  palate,  but  with  a  psychically  established  and 
deepened  radiation,  which  at  times  is  capable  of  heightening  and  is 
related  to  an  affect  phenomenon.  In  this  conclusion  I  am  sup- 

4 


4O  STUDY  OF  ORGAN  INFERIORITY 

ported  by  the  following  results:  the  test  for  vomiting  reflex  by 
touching  the  pharynx,  or  the  back  pharyngeal  wall,  is  often  posi- 
tive, whereas  touching  the  soft  palate  gives  no  result ;  in  these  cases 
the  soft  palate  seems  to  be  outside  the  reflex  zone.  This  condition 
is  found  quite  often  in  children  up  to  their  second  or  third  year. 
In  addition  to  that,  it  struck  me,  that  in  little  children  by  touching 
the  back  pharyngeal  wall  no  vomiting  reflex,  but  frequently  cough- 
ing results,  a  fact  which  strengthens  my  conception  that  reflex 
anomalies  of  the  palate  and  pharynx,  as  well  as  stigmata  in  these 
parts  discussed  before  may  also  originate  from  an  inferiority  of 
the  respiratory  apparatus.  The  spreading  of  the  vomiting  reflex 
zone  to  the  soft  palate  may  be  brought  about  by  repeated  tests  or 
sudden  contacts  expected  beforehand  by  the  patient,  and  the  result 
is  then  no  longer  free  from  objections.  My  conception  derives 
further  proof  from  the  fairly  frequent  cases  which  show  the 
vomiting  reflex  even  before  touching  the  soft  palate.  Thus  I 
could  call  forth  an  increased  vomiting  reflex  in  a  four-year-old  girl 
when  I  put  a  thin  little  rod  back  of  the  teeth,  without  touching  the 
palate  or  the  tongue,  which  was  all  the  more  striking,  as  the  child 
in  consequence  of  a  cleft  of  the  hard  palate  showed  a  defect  of  the 
central  back  portion  of  the  soft  palate.  In  three  cases  it  was  im- 
possible for  me  even  to  succeed  in  opening  the  mouth.  The  in- 
spection was  always  denied  with  laughing,  anxiety  and  indications 
of  choking  movements.  Two  of  the  cases  had  to  do  with  cooks 
who  had  been  in  service  in  Vienna  for  some  time  and  who  were  not 
at  all  unintelligent.  Injuries  of  the  mouth,  of  which  they  might 
have  been  somewhat  ashamed,  were  not  present.  The  third  case 
was  that  of  a  cultured  woman  who  had  been  suffering  from  re- 
curring abscesses  of  the  tonsils  for  many  years.  The  incision  had 
to  be  given  up  each  time  on  account  of  the  impossibility  of  getting 
a  probe  or  a  knife  into  the  patient's  mouth.  I  found  the  same 
state  of  affairs  at  times  when  no  abscesses  had  formed.  Two  of 
the  patient's  sons  acted  similarly  which  gave  one  the  impression  that 
the  vomiting  reflex  zone  had  extended  to  the  eyes  and  was  irritated 
by  the  very  expectation  of  touching  the  pharynx.  The  touching  of 
the  palate  may  occur  once  and  without  having  the  person  examined 
expect  it,  but  in  contrast  to  touching  the  back  pharyngeal  wall  it 
exhibits  the  more  delicate  reagent  to  the  reflex  activity  of  the 
pharynx. 

Still  easier  to  comprehend  is  the  control  of  this  reflex  activity 
by  the  will.  And  yet  I  think  that  a  certain  degree  of  heightened 
choking  reflex  can  not  be  completely  checked  by  the  will. 


AND   ITS    PSYCHICAL   COMPENSATION  4! 

These  reflections  and  the  impression  which  I  obtained  from  a 
great  number  of  nursing  infants  and  little  children,2  that  the  pharyn- 
geal  reflex  is  a  product  of  the  psychomotor  sphere  in  the  post- 
embryonic  period,  permit  me  to  classify  all  anomalies  of  the  reflexes 
of  the  mucous  membranes  as  defective  functioning  of  an  inferior 
organ.  The  pure  type  of  this  deficient  performance  which  shows  a 
strong  relationship  to  the  infantile  anomalies,  spoken  of  earlier,  is 
the  lack  of  the  reflex,  while  the  increase  is  to  be  considered  in  the 
light  of  over-compensation.  The  occurrences  which  lead  to  the 
heightening  of  the  reflex  are  openly  related  to  inferior,  but  func- 
tionally capable  nerve  material,  increase  their  energy  and  influence 
over  the  reflex  zones  and  thus  attain  the  higher  reflex  technic.  As 
we  shall  show  later,  the  inferior  organ  with  its  psychical  super- 
structure almost  always  is  in  the  focus  of  its  bearer's  interest. 
It  is  the  unsuccessful  but  indulged  organ  which  keeps  the  psyche 
in  a  state  of  continual  irritation  on  account  of  conscious  or  uncon- 
scious attention.  Newly  arriving  stimuli — for  the  way  to  the  brain 
is  usually  undisturbed  in  spite  of  deficient  reflex — little  by  little 
come  into  a  realm  of  higher  psychical  tension,  which  grows  greater 
the  less  motor  reflexes  lead  from  it.  This  condition  may  last 
through  the  whole  lifetime.  Very  frequently  however  and  evi- 
dently as  a  sort  of  compensation  a  heightening  of  reflex  capacity 
appears  to  take  place  in  childhood,  which  bears  witness  in  the  same 
manner  to  the  fundamental  inferiority  of  the  related  organ,  and  at 
times  of  the  segment  also. 

As  to  the  results  of  my  investigations  in  regard  to  the  palatal 
reflex,  they  fit  in  very  well  with  my  former  representations  just  as 
did  the  experiments  with  the  conjunctival  reflex.  We  find  a  lack 
or  a  heightening  of  the  palatal  reflex  in  the  most  varied  diseases  of 
the  nutritive  and  respiratory  tracts,  above  all  in  angina,  pulmonary 
tuberculosis,  diseases  of  the  nose  and  larynx  and  in  certain  pro- 
fessions, in  following  which  the  compliance  of  an  inferior  or  over- 
compensated  organ  is  necessary,  as  in  singers,  speakers  and  players 
of  wind  instruments.  In  all  these  cases,  I  could  be  sure  of  a  pre- 
dominance of  reflex  deficiency.  The  objection  that  there  exists  no 
coordination  here,  but  an  anomaly  conditioned  by  the  disease,  or 
the  profession,  I  can  set  aside  merely  with  reference  to  the  hered- 
ity of  the  reflex  anomaly ;  the  extraordinary  or  deficient  palatal  re- 
flex is  almost  always  met  with  again  in  closely  related  members  of 
the  family,  and  without  having  any  connection  between  the  anom- 
aly and  disease  or  profession.  But  on  the  other  hand  my  concep- 

2  I  am  indebted  to  the  kindness  of  Dr.  Rie  for  a  portion  of  this  material. 


42  STUDY   OF   ORGAN    INFERIORITY 

tion  gives  an  explanation  of  the  fact,  that  so  frequently  members 
of  the  same  family  have  the  same  disease  or  repeatedly  follow  the 
same,  usually  artistic,  profession.  A  third  fact  can  not  be  over- 
looked, namely,  that  the  anomaly  may  be  present,  without  being  con- 
nected with  the  disease  or  profession,  and  reflex  capacity  may  ap- 
pear normal  in  spite  of  disease  or  profession,  for  reasons,  which 
we  have  already  introduced  several  times,  particularly  that  the  in- 
feriority of  the  organ  may  manifest  itself  in  other  ways  or  at  an- 
other point.  Perhaps  still  more  often  is  the  connection  between 
palatal  reflex  anomalies  and  gastro-intestinal  diseases  established. 
Above  all  it  seems  to  me  that  the  lack  of  the  palatal  reflex,  the 
rarely  important  heightening,  up  to  the  disappearance  of  the  uvula, 
is  almost  regularly  connected  with  hysterical  manifestations  of  the 
gastro-intestinal  apparatus,  and  at  times  of  the  respiratory  tract. 
Hysterical  eructation,  vomiting,  singultus,  crying  fits,  aphonia,  the 
many-sided  picture  of  intestinal  and  gastric  neuroses  almost  always 
show  palatal  reflex  anomalies.  If  the  ruling  conception  regards  the 
lack  of  palatal  reflex  as  a  ground  for  suspicions  of  hysteria,  those 
who  follow  this  concept  are  right  to  a  certain  degree,  but  their  op- 
ponents are  just  as  much  in  the  right  because,  as  we  shall  see  later, 
the  hysterical  manifestations  may  take  their  starting  point  from 
other  inferior  organs  so  that  the  oral  zone  then  appears  as  normal. 
As  regards  organic  diseases,  I  could  be  sure  that  between  appen- 
dicitis, pseudo-appendicitis,  ulcus  rotundum,  gall-stone  diseases, 
diabetes,  carcinoma  of  the  gall-bladder,  chronic  constipation,  obes- 
ity, perhaps  even  chronic  alcoholism,  and  our  reflex  anomalies,  the 
same  connections  had  weight,  as  could  be  proved  between  disease 
and  childish  defects,  or  between  disease  and  stigma. 

I  can  not  forbear  to  show  at  this  point  how  great  is  the  relation- 
ship between  reflex  anomalies  and  childish  defects.  Both  are  func- 
tional anomalies  of  the  inferior  organ  which  may  last  until  an  end 
is  made  by  the  compensatory  intervention  of  the  central  nervous 
system,  the  psyche.  Furthermore  the  manner  of  manifestation  of 
many  children's  defects  is  nothing  else  than  an  unusually  continuing 
heightened  reflex.  This  is  the  case  in  blepharospasm,  more  rarely 
nystagmus,  thumb  sucking  and  lip  sucking  (see  the  sucking  re- 
flex), stuttering,  vomiting,  enuresis,  incontinentia  alvi.  All  these 
are  aroused,  not  from  the  outside,  but  from  within  and  are  under 
the  impulse  of  the  central  nervous  system.  They  are  transformed 
methods  of  function  of  the  inferior  organ,  which  come  to  light  in 
infantile  errors  as  well  as  in  the  reflex  anomalies  and  these  obey 
the  compensating  and  over-compensating  power  of  the  portion  of 
the  psychomotor  sphere  which  has  now  attained  super-value. 


AND   ITS    PSYCHICAL    COMPENSATION  43 

In  the  following  I  will  trace  the  relationship  of  childish  defects 
and  reflex  anomalies  to  enuresis  still  further.  I  can  scarcely  ex- 
pect a  serious  objection  if  I  place  this  affection  among  the  number 
of  functional  inferiorities.  The  opinions  of  individual  authors  who 
think  that  organic  hypoplasias  may  be  found  in  the  bladder  or  in 
the  central  nervous  system,  can  change  nothing  in  this  conception, 
and  moreover,  are  in  harmony  with  my  ideas  concerning  external 
and  internal  stigmata.  Now  in  the  symptomatology  of  enuresis 
there  is  a  characterizing  sign,  according  to  which  a  direct  division 
into  two  forms  was  attempted :  namely  the  behavior  of  the  sphincter 
in  catheterization,  which  appears  now  as  atony  (lack  of  reflex), 
again  as  strengthened  tonicity,  as  a  spasm  (heightened  reflex).  In 
this  opposed  behavior  we  can  recognize  the  already  familiar  reflex 
anomalies  of  the  inferior  organ  and  we  would  be  in  a  position  from 
this  reflex  anomaly  alone — enuresis,  this  childish  defect,  need  not 
always  appear  in  spite  of  inferiority  of  the  urinary  apparatus — to 
infer  the  state  of  things,  namely  to  surmise  the  inferiority  of  the 
urinary  apparatus  or  the  sexual  apparatus  in  the  family. 

If  we  have  to  do  with  reflex  paralyses  following  upon  organic 
nervous  diseases,  we  must  not  forget  at  the  same  time  that  accord- 
ing to  the  established  principles  the  organic  disease  is  localized  in 
the  inferior  channels.  We  must  think  particularly  of  the  phenom- 
ena of  segmental  inferiority,  which  surely  plays  a  part  in  tabes,  in 
occupation  diseases,  writer's  cramp,  etc.,  in  pseudohypertrophy  and 
Erb's  disease. 

The  brother  of  a  physician  fell  ill  of  tabes  dorsalis,  which  for 
some  time  manifested  itself  as  atrophy  of  the  optic  nerve.  The  doc- 
tor himself  and  several  of  his  brothers  and  sisters  had  in  their 
childhood  suffered  from  blepharospasm.  The  conditions  might  be 
similar  in  tabetic  bladder  and  rectal  disturbances,  in  ataxia,  girdle 
sensation,  larynx  and  gastric  crises,  whereas  in  paresis  a  funda- 
mentally inferior  brain  may  be  surmised. 

I  should  like  to  introduce  the  following  case  in  regard  to  the 
significance  of  the  palatal  reflex  anomalies  in  connection  with  dis- 
eases of  the  air  passages  and  the  nutritive  tract. 

Heinrich  R.,  merchant,  52  years  old  (already  mentioned),  has 
for  many  years  suffered  from  frequent  tenesmus  with  diarrheal 
evacuation.  Ten  years  previously  he  had  a  violent  attack  of  gall- 
stones which  was  completely  cured  at  Karlsbad.  One  of  the  pa- 
tient's brothers,  a  doctor,  was  operated  on  by  Kehr  for  the  same 
affection.  The  mother  suffered  from  enlargement  of  the  liver. 
Palatal  reflex  in  the  patient  negative.  His  son,  Herbert,  sixteen 


44  STUDY  OF  ORGAN  INFERIORITY 

years  old  had  appendicitis  four  years  ago,  which  was  completely 
cured  after  internal  treatment.  At  that  time  there  was  obstinate 
constipation.  No  palatal  reflex,  slight  defect  of  speech,  slight  de- 
gree of  epignathia.  One  the  patient's  daughters  has  very  stubborn 
constipation.  No  palatal  reflex.  The  youngest  son,  n  years  old, 
shows  epignathia  to  a  slight  degree,  has  a  defect  in  speech  like  his 
brother,  no  palatal  reflex.  In  this  case  I  wish  to  emphasize  the 
inheriting  of  the  lack  of  palatal  reflex  and  the  fairly  radical  intes- 
tinal inferiority  in  the  family  which  reveals  itself  in  different  dis- 
eases, as  well  as  in  a  decided  tendency  towards  obesity. 

Mrs.  Amalie  B.,  61  years  old  was,  as  a  child,  very  weak  and 
thin  and  is  supposed  at  times  to  have  suffered  from  hemoptysis. 
Since  her  twentieth  year  she  has  gained  a  great  deal  of  weight  in 
spite  of  continually  practised  self-denial  in  diet.  No  palatal  reflex. 
Of  her  five  sons,  in  three  I  could  find  the  same  lack  of  palatal  reflex, 
the  fourth  had  died  in  dabetic  coma.  I  never  examined  this  one 
or  the  fifth  son.  Nevertheless  I  point  to  my  cases  of  diabetes  in 
which  also  the  palatal  reflex  was  wanting.  The  oldest  son  is  ap- 
parently healthy,  the  second  of  the  three  whom  I  examined  is  obese, 
inclines  to  constipation  and  is  troubled  by  recurring  anal  fissures 
and  by  anal  eczema.  The  third  was  operated  on  a  year  ago  for 
appendicitis,  after  numerous  feverish  attacks  in  the  region  of  the 
cecum  had  been  occurring  for  four  years.  With  the  operation 
came  exudative  pleuritis  on  the  right  side  and  double  infiltration 
into  the  apex  of  the  lung,  which  turned  out  favorably.  Heredity 
of  reflex  anomalies  such  as  in  the  first  case,  demonstrable  hereditary 
inferiorities  of  the  nutritive  and  respiratory  tract,  and  at  the  same 
time  variations  in  the  diseases  of  the  nutritive  tract  (appendicitis, 
diabetes,  anal  fissures),  and  at  times  only  adiposity  are  found  in 
reviewing  the  family.  In  addition  to  this  we  find  at  the  same  time 
inferiority  of  the  respiratory  tract,  which  reveals  itself  in  disease 
in  the  mother  and  one  of  the  sons.  Further  on  there  will  be  some 
facts  in  regard  to  the  connection  between  palatal  reflex  anomalies 
and  pulmonary  tuberculosis. 

Kdthe  H.  (see  III),  governess,  24  years  old,  was  operated  on  6 
months  ago  for  appendicitis.  Four  years  ago  there  was  hemate- 
mesis.  Teeth  lacking  in  the  upper  jaw,  palatal  reflex  heightened. 

In  Friederike  U.  (see  III)  and  both  her  sisters  we  also  find 
heightening  of  the  palatal  reflex  up  to  the  point  of  disappearance  of 
the  uvula,  while  in  Friederike  there  was  appendicitis,  prognathia, 
adenoid  growth,  defects  of  speech,  and  in  her  oldest  sister,  prog- 
snathia,  gastric  neuroses  and  anal  fissures. 


AND   ITS    PSYCHICAL    COMPENSATION  45 

Hugo  R.,  writer,  34  years  old,  was  stricken  at  the  beginning 
of  his  twentieth  year,  with  pulmonary  tuberculosis  which  appeared 
rather  serious  and  was  accompanied  by  frequent  hemoptysis.  After 
spending  about  two  years  at  the  sanatorium  at  Alland,  he  took  up 
his  profession  again  three  years  ago  much  improved  and  since  then 
has  been  uninterruptedly  active.  He  shows  complete  lack  of  the 
palatal  reflex.  The  patient  comes  from  a  family  which  has  given 
us  several  prominent  actors  (oral  inferiority).  His  sister  also, 
who  died  of  pulmonary  tuberculosis,  was  active  for  a  time  as  an 
actress. 

Maria  A.,  24  years  old,  a  governess,  is  being  treated  for  hemop- 
tysis. Left-sided  infiltration  into  the  apex.  A  sister  also  has  for 
some  time  had  pulmonary  tuberculosis  which  apparently  ran  a  light 
course.  In  both  of  them  conjunctival  and  palatal  reflexes  are  lack- 
nig.  The  patient  suffered  for  some  time  from  frequent  loud  eruc- 
tations and  singultus  and  as  a  child  vomited  easily  and  very  often. 
Even  at  the  present  time  she  feels  a  provocation  to  vomit  when  she 
is  brushing  her  teeth.  In  spite  of  deficient  palatal  reflex  sensation 
of  a  globus  often  occurs  as  well  as  headaches.  Individual  members 
of  the  family,  particularly  the  father  (civil  engineer),  show  ability 
to  draw  (lack  of  conjunctival  reflex,  inferiority  of  the  organs  of 
vision,  psychical  over-compensation) .  The  lack  of  the  palatal  reflex 
here  is  related  not  only  to  an  inferiority  of  the  respiratory  appara- 
tus, the  missing  pharyngeal  reflex  is  evidently  connected  with  the 
hysterical  manifestations  of  the  nutritive  apparatus!  I  often  find 
nausea  as  an  affect  and  inclination  to  vomit  in  children  and  older 
people  connected  with  deficient  palatal  reflex. 

In  order  not  to  weary  with  enumerations  and  descriptions,  I  will 
only  present  briefly  a  few  more  cases  and  will  emphasize  their  char- 
acteristic features.  The  analysis  of  each  case  is  easy  to  make  after 
what  has  gone  before. 

Therese  M.,  27  years  old,  chambermaid,  apex  infiltration  on  the 
left  side,  coughs  a  great  deal,  and  has  in  the  last  3  months  become 
greatly  emaciated  and  suffers  from  night-sweats.  Palatal  reflex 
greatly  heightened. 

In  this  group  belong  the  cases  already  mentioned  in  other  con- 
nections : 

Johann  K.,  25  years  old,  a  student,  tuberculosis  of  the  left 
superior  lobe,  dry  pleurisy  on  the  left  side,  and  hemoptysis  6  years 
ago,  nevi  pigmentosi  on  the  thorax.  No  palatal  reflex. 

Fanny  H.,  a  teacher,  23  years  old,  began  spitting  of  blood; 
apex  infiltration  on  the  left  side,  constipation  of  long  standing. 


46  STUDY  OF  ORGAN  INFERIORITY 

The  mother  died  of  consumption,  the  sister  has  a  lung  disease. 
The  right  half  of  the  thorax  is  better  developed  than  the  left. 
No  palatal  reflex,  no  pharyngeal  reflex.  The  lack  of  the  latter  evi- 
dently has  to  do  with  the  constipation. 

Wladimir  T.,  23  years  old,  a  student,  has  been  coughing  for  two 
months ;  resonance  RHO  contracted,  and  gentle  rattling  in  inspira- 
tion which  only  disappears  at  the  spina  scapulae.  Nevus  pigmen- 
tosus  over  the  middle  of  the  right  shoulder  blade.  In  her  youth,  the 
mother  had  suffered  from  catarrh  of  the  apex  of  the  lung,  and  a 
brother  is  being  treated  at  Davos  for  infiltration  into  the  apex  of 
the  right  lung.  Heightened  palatal  reflex,  and  on  touching  the 
soft  palate  the  uvula  disappears  almost  entirely. 

Further  cases  are  the  following: 

Berta  Sp.,  23  years  old,  a  cook.  Hemoptysis  for  the  last  two 
months;  the  patient  continued  with  her  work.  Infiltration  of  the 
left  upper  lobe  of  the  lung.  There  is  a  nevus  pigmentosus  in  the 
region  of  the  spinous  process  of  the  seventh  cervical  vertebra.  The 
teeth  of  the  upper  jaw  have  fallen  out,  while  the  lower  incisor  teeth 
are  horizontally  notched.  Chronic  constipation.  The  father  died 
young  of  pulmonary  phthisis.  No  palatal  reflex.  No  pharyngeal 
reflex. 

Josefine  Sch.,  21  years  old,  is  suffering  from  loss  of  appetite 
and  frequent  vomiting.  As  a  child  she  was  chronically  constipated 
and  often  vomited,  particularly  when  angry.  Since  puberty  vomit- 
ing occurs  regularly  during  her  period.  In  the  last  three  years  she 
has  had,  somewhat  periodically,  violent  pains,  colic,  in  the  ileocecal 
region.  There  is  also  great  sensibility  to  pressure.  The  appendix 
may  be  felt  as  a  thickened  cord.  Diarrhea  as  reported  rare,  vomit- 
ing latterly  more  frequent.  Rales  in  the  upper  right  superior  lobe, 
night-sweats,  no  palatal  reflex,  no  pharyngeal  reflex. 

Siegfried  M.,  33  years  old,  a  merchant ;  apex  infiltration  on  both 
sides,  great  emaciation.  No  palatal  reflex. 

Anna  R.,  28  years  old,  landlady,  every  year  has  several  attacks 
of  angina  tonsillaris.  A  brother  died  of  tuberculosis,  the  father 
has  emphysema.  The  patient  has  sound  lungs.  There  is  a  nevus 
pigmentosus  over  the  left  clavicle.  One  of  the  patient's  uncles  on 
her  father's  side  is  a  formidable  orator,  an  obstructionist  speaker, 
who  speaks  very  often  in  assemblies.  The  patient  shows  lack  of 
palatal  reflex.  Pharyngeal  reflex  normal. 

I  have  repeatedly  referred  to  the  fact  that  I  have  been  obliged 
to  consider  diabetes  mellitus  as  well  as  most  of  the  glycosurias  as 
diseases  of  an  inferior  nutritive  apparatus,  particularly  of  an  in- 


AND   ITS    PSYCHICAL    COMPENSATION  47 

ferior  pancreas  and  liver.  I  once  more  call  attention  to  heredity  in 
these  affections,  to  the  connection  with  intestinal  diseases  in  the 
patient  and  his  relatives,  to  the  appearance  of  psychoses  and  neuroses 
in  diabetic  cases  and  members  of  their  families,  to  external  stig- 
mata and  children's  anomalies  in  the  anamnesis.  I  can  add  at  this 
point,  too,  that  from  a  small  number  of  cases  I  became  convinced 
that  the  reflex  capacity  of  the  palate  in  glycosuria  and  diabetes 
shows  the  same  anomalies  as  in  other  diseases  of  the  inferior  gastro- 
intestinal tract;  the  palatal  reflex  has  usually  disappeared  and  this 
defect  must  serve  as  a  token  of  organ  inferiority.  The  deficiency 
of  the  patellar  reflex  in  cases  of  diabetes  has,  to  be  sure,  another 
significance,  namely  that  of  an  indication  of  the  segmental  in- 
feriority. 

Here  are  the  diabetic  cases  just  as  I  have  met  with  them  re- 
cently : 

David  W .,  25  years  old,  a  student,  suffered  in  his  youth  from  ob- 
stinate constipation.  Four  years  ago  his  diabetes  was  discovered, 
during  the  development  of  which  a  great  deal  of  sugar  was  excreted, 
with  periodic  acetonuria  and  excretion  of  diacetic  acid.  Tolerance 
very  slight.  No  further  cases  of  diabetes  in  the  family.  The  father 
suffered  from  attacks  which  lasted  for  months  when  he  could  not 
walk  nor  speak.  One  sister  suffered  from  a  temporary  psychosis. 
The  patient  lisps  very  noticeably  still.  The  patellar  reflexes  are 
greatly  diminished  on  both  sides,  and  palatal  and  pharyngeal  re- 
flexes are  lacking. 

Mar  git  B.,  mentioned  in  II ;  constipation  extending  to  her  earliest 
childhood,  defects  of  speech,  attacks  of  singultus  in  puberty,  hys- 
terical anxiety.  No  palatal  reflex  and  a  very  weak  pharyngeal 
reflex.  The  father  died  of  diabetes.  A  brother  suffered  up  to  his 
twelfth  year  from  incontinentia  alvi,  a  sister  had  hysterical  at- 
tacks of  unconsciousness.  Here  also  we  find  the  connection  be- 
tween reflex  anomalies  and  diabetes,  neurosis  and  infantile  defects, 
distributed  at  any  rate  among  the  individual  members  of  the  family. 

Otto  C.,  already  mentioned.  Died  in  diabetic  coma.  As  a 
child  had  suffered  greatly  from  incontinentia  alvi.  His  father  has 
been  constipated  all  his  life.  His  sister  also  suffered  for  a  long 
time  from  constipation  and  fell  ill  very  early  with  violent  hysteria. 
Both  father  and  sister  show  lack  of  palatal  reflex. 

Josef  A.,  37  years  old,  a  furrier,  complains  of  impotence  and 
ejaculatio  precox.  Examination  shows  a  great  deal  of  sugar  in  the 
urine.  No  palatal  reflex.  No  patellar  reflex. 

Regina  D.,  38  years  old,  the  wife  of  a  lawyer,  complains  of 


48  STUDY  OF  ORGAN  INFERIORITY 

pruritus  vulvse  and  many  nervous  troubles.  A  great  deal  of  sugar 
and  acetone  in  the  urine.  Patient's  father  died  in  diabetic  coma. 
Two  sisters  have  hysterical  affections.  In  all  three  sisters  there 
is  a  lack  of  palatal  and  pharyngeal  reflexes.  Patellar  reflex  normal. 
One  sister  sucked  her  thumb  for  a  long  time. 

Anton  M.,  40  years  old,  a  caterer,  shows  a  slight  defect  in 
speech  and  lacks  palatal  reflex.  Pharyngeal  reflex  present.  Pa- 
tient's mother  has  diabetes. 

David  K.,  whom  I  mentioned  earlier,  belongs  in  this  group. 
Carcinoma  of  the  gall-bladder  ,glycosuria.  His  difficulties  began 
with  loss  of  appetite  and  emaciation  two  years  before  his  death. 
No  palatal  and  no  pharyngeal  reflex.  Patellar  reflex  not  tried. 
Two  daughters  show  epignathia;  one  of  them  suffers  from  hyster- 
ical coughing  and  loss  of  appetite. 

As  I  have  already  stated,  we  almost  always  find  lack  of  palatal 
reflex  in  people  who  frequently  have  sore  throats.  I  also  found 
the  same  condition  in  a  case  of  herpes  pharyngis  in  a  man  who  had 
suffered  for  some  time  from  flatulence  and  from  an  umbilical  hernia. 

The  case  of  a  hysterical  patient,  Dr.  Heinrich  O.,  in  whom  there 
were  indications  of  spina  bifida  sacralis  and  adenoid  growths,  seems 
worthy  of  mention.  The  patient  very  often  made  a  grunting  noise 
and  one  day  presented  himself  with  aphthae  of  the  palate  and 
pharynx.  I  also  saw  reflex  anomalies  in  several  cases  of  ulcus  ro- 
tundum  and  in  relatives  of  these  patients.  In  chronic  alcoholics 
one  usually  finds  heightening,  but  also  lack  of  the  palatal  reflex. 
These  anomalies  are  surely  not  to  be  considered  as  conditions  re- 
sulting from  alcoholism.  They  show  rather  that  chronic  alcoholism 
is  dependent  upon  an  organic  cooperation  as  a  foundation  of  an  in- 
ferior gastro-intestinal  tract.  I  also  saw  a  case  of  diabetes  insipidus 
with  palatal  and  pharyngeal  reflexes  lacking.  I  have  already  em- 
phasized the  relation  of  obesity  to  the  inferiority  of  the  nutritive 
tract.  The  reflex  anomalies  which  have  been  discussed  are  often 
met  with  under  this  condition. 

I  introduced  a  case  in  regard  to  lack  of  conjunctival  reflex  as 
evidence  of  inferiority  of  the  eye  in  Chapter  I.  At  this  point  I 
have  a  second  to  offer. 

Elsa  R.,  22  years  old,  was  treated  for  a  foreign  body  in  the 
right  eye.  The  blue  colored  iris  of  the  right  eye  is  colored  brownish 
at  a  point  in  the  upper  outer  quadrant.  Normal  sharpness  of  vi- 
sion. No  conjunctival  reflex.  The  coincidence  of  stigmas,  reflex 
anomalies  and  foreign  bodies  here  also  raises  a  suspicion  of  in- 
feriority. 


AND   ITS    PSYCHICAL    COMPENSATION  49 

I  have  already  mentioned  the  painter  Karl  v.  R. — photophobia, 
conjunctivitis  lymphatica  in  youth,  thin  eyelashes,  blinking  in  the 
brother.  I  must  add  that  in  this  case  also  the  conjunctival  reflex 
is  wanting. 

In  a  similar  manner  reflex  anomalies  are  found,  usually  lack  of 
palatal  reflex,  in  people  who  have  attained  to  higher  sorts  of  work 
by  conquering  the  fundamental  inferiority  of  their  respiratory  tract 
or  nutritive  apparatus.  I  have  already  emphasized  three  categories 
of  these  several  times  in  other  connections,  singers,  speakers,  and 
cooks ;  I  must  still  mention  gourmands  in  whom  I  have  almost 
always  found  the  palatal  reflex  has  become  extinct,  and  in  fact  in  a 
large  number  of  cases.  To  these  categories  I  can  still  add :  an  oboe 
player,  a  trumpeter  and  a  heavy  smoker. 


CHAPTER  VI 
MANIFOLD  ORGAN  INFERIORITIES 

Even  though  the  fundamental  principles  of  a  theory  of  inferior- 
ity, which  I  have  just  laid  down,  are  confirmed  (of  which  I  have 
no  doubt),  nevertheless  it  is  rather  striking  that  their  relation  to 
pathology  has  not  hitherto  been  clearly  recognized.  The  final  reason 
for  this  seems  to  me  to  lie  in  the  fact  that  the  picture  of  organ 
inferiority  has  been  only  too  often  obscured  by  the  intrusion  of 
further  organ  inferiorities  and  has  been  made  unrecognizable.  Dis- 
cernment is  still  more  difficult  in  this  connection,  when  one  is 
forced  to  determine  the  inferiority  in  the  family  from  the  statements 
of  one  patient  alone.  Usually  available  reports  are  of  diseases  in 
members  of  the  family,  obtained  during  their  lives  or  about  affections 
which  led  to  their  deaths.  A  test  for  other  organ  inferiorities  which 
may  have  been  unnoticed,  but  which  are  particularly  noticeable 
in  the  patient  examined,  often  can  not  be  carried  out.  On  the 
other  hand  there  is  fortunately  such  a  lot  of  explicable  material, 
particularly  in  the  family  physician's  practice,  that  in  spite  of  indi- 
vidual gaps,  owing  to  the  difficulty  of  producing  the  material,  the 
foundation  of  a  theory  of  organ  inferiority  may  be  considered  as 
fully  established. 

A  second  phenomenon,  which  is  closely  connected  with  this,  Is 
still  more  highly  adapted  to  conceal  the  existing  circumstances.  For 
very  often  organic  diseases  can  be  found  in  almost  every  individual 
member  of  a  family,  but  they  concern  entirely  different  organs,  and, 
accordingly,  seem  to  gainsay  the  claims  based  on  the  inheritance  of 
organ  inferiority.  But  in  such  cases  also  the  connection  may  often 
be  discovered  and  the  proof  of  multiple  organ  inferiority  may  be 
secured  by  information  concerning  childish  defects  or  reflex  anoma- 
lies. The  following  is  such  a  case,  one  which  I  have  already  used 
in  the  carcinoma  theory  and  which  I  discuss  more  at  length  here : 

Therese  S.  died  at  46  years  of  age  after  an  operation  for  carci- 
noma of  the  uterus.  Her  husband,  Samuel  S.,  at  that  time  51 
years  old,  has  suffered  since  his  4Oth  year  from  rare  attacks  which 
are  accompanied  by  sudden  collapse  and  a  short  period  of  uncon- 
sciousness. Injuries  frequently  occur  in  this  way.  Difficulties  in 
recollecting  after  the  attack,  amnesia  and  stammering  afterward, 

50 


STUDY  OF  ORGAN  INFERIORITY  5! 

speak  for  the  epileptic  nature  of  the  affection.  It  is  impossible  to 
make  a  psychical  analysis  of  these  attacks  which  occur  about  twice 
a  year.  The  patient  has  chronic  constipation.  A  son,  Alexander 
S.,  23  years  old,  suffered  until  his  sixth  year  from  involuntary  mic- 
turition and  defecation,  had  scarlet  fever  in  his  twenty-first  year, 
which  was  followed  by  nephritis.  Occasionally,  a  year  later,  there 
are  still  traces  of  albumin,  and  quite  often  excess  of  phosphates  too. 
Sexual  abstinence,  even  for  a  short  time,  calls  forth  the  most  vio- 
lent conditions  of  excitement,  fear  of  beginning  insanity  and  violent 
and  lasting  palpitation  of  the  heart.  Ejaculatio  precox.  The 
daughter  suffers  from  vomiting  on  the  slightest  provocation,  ab- 
dominal colic  and  diarrheal  evacuation.  From  time  to  time  anal 
fissures  appear.  Painful  menses,  protracted  labor.  Her  six  year 
old  son  is  an  enuretic.  All  four  survivors  show  lack  of  palatal 
reflex.  The  inferiority  of  the  intestinal  tract  and  of  the  central 
nervous  system  inherited  from  the  father  reveals  itself  characteris- 
tically in  the  daughter  in  the  same  manner:  psychical  insufficiency 
toward  external  impressions  and  motor  defect  in  the  inferior  gastro- 
intestinal tract,  which  is  stigmatized,  besides,  by  the  lack  of  palatal 
reflex  and  by  the  anal  fissures.  The  mother's  inheritance,  inferior- 
ity of  the  sexual  apparatus,  reappears  in  dysmenorrhea  and  the  pro- 
tracted labor.  Even  the  son  shows  in  the  accompanying  psychical 
phenomena  of  his  sexual  abstinence  and  in  his  involuntary  defeca- 
tion the  inferiority  of  the  same  organs  that  we  have  noticed  in  his 
father.  Enuresis  and  the  same  trouble  in  his  nephew,  points,  how- 
ever, just  as  did  the  nephritis,  to  an  inferiority  of  the  urinary  ap- 
paratus, which,  as  we  shall  show  later,  is,  perhaps,  regularly  con- 
nected with  the  inferiority  of  the  sexual  apparatus  (ejaculatio  precox 
in  the  son,  carcinoma  of  the  uterus  in  the  mother).  That  fre- 
quently, adjoining  organs,  and  also  those  at  a  greater  distance,  take 
part  more  or  less  in  the  inferiority,  gives  us  evidence  in  the  first 
place,  of  reciprocal  embryonic  influence,  and  also  arises  from  the 
embryonic  connection  of  many  an  organ,  while  more  distant  organs 
may  be  influenced  by  hereditarily  conditioned  degeneration  of  the 
germ-plasma  in  numerous  places,  by  early  correlation  of  certain 
organs,  but  also  by  a  superimposed  inferiority  of  the  circulatory  or 
of  the  central  nervous  system.  In  the  last  case,  particularly,  it 
would  not  suprise  us  to  see  aggregated  organ  inferiority  appear,  in 
case  the  vital  capacity  of  the  embryo  seems  assured. 

Our  assertions  have  been  mightily  supported  hitherto  by  the 
conceptions  and  reports  of  clinical  medicine  which  has  long  been 
familiar  with  the  connection  of  many  organic  diseases.  If  we  com- 


52  STUDY  OF  ORGAN  INFERIORITY 

pare  our  results  in  regard  to  manifold  inferiority,  and  if  we  con- 
sider them  in  those  cases  in  which  the  diseases  reveal  them  most 
clearly,  it  becomes  evident  that  we  can  speak  of  simultaneous,  co- 
ordinate inferiority,  where  the  former  conception  had  usually  de- 
termined diseases  as  dependent  upon  each  other.  This  is  the 
case  in  regard  to  two  pairs  of  organs,  whose  belonging  together 
is  also  proved  by  the  common  terminal  issue,  in  respect  to  the  re- 
spiratory, digestive  and  the  urino-genital  tracts.  For  each  of  these 
pairs  we  have  already  found  common  stigmata  and  reflex  anomalies 
as  indications  that  inferiority  is  present.  We  can  draw  new  evi- 
dence from  clinical  medicine.  Gastro-intestinal  affections  in  dis- 
eases of  the  lungs,  in  emphysema  and  particularly  in  tuberculosis 
are  sufficiently  known,  and  yet  their  dependence  upon  a  primary 
lung  disease  seems  to  be  too  strongly  stressed.  We  find  that  it 
is  oftener  the  case  for  them  to  be  entirely  lacking,  or  to  precede 
the  lung  disease  by  some  time,  and  that  they  even  extend  back  to 
the  earliest  childhood.  We  uphold  the  same  conception  also  in 
regard  to  the  connection  of  diseases  in  the  urinary  and  genital 
tracts.  Aside  from  the  frequency  of  simultaneous  structural  anom- 
alies in  both  organs,  similar  reasoning  respecting  simultaneous  in- 
feriority is  entirely  in  place.  Frequent  miscarriage  in  renal  affec- 
tions is  universally  considered  the  result  of  the  latter.  All 
justification  is  lacking  for  this  conviction,  since  normal  parturition 
occurs  in  renal  diseases  and  manifold  miscarriages  without  patho- 
logic conditions  are  not  at  all  rare.  The  same  thing  is  true  in 
pyelitis  of  pregnancy.  Nevertheless  I  wish  to  stress  emphatic- 
ally, that  neither  a  one-sided  nor  mutual  influence  is  ruled  out 
through  inferior  organs.  But  the  simultaneousness  of  organ  inferi- 
ority deserves  special  consideration,  since  through  it,  it  would  be 
possible  to  obtain  greater  insight  into  pathology.  The  influenc- 
ing of  the  circulatory  apparatus,  particularly  of  the  heart,  in  a 
renal  disease  is  certainly  plausible  according  to  the  material  at 
hand.  By  accepting  a  simultaneous  inferiority  of  the  vascular 
system,  the  hypertrophic  heart  becomes  more  comprehensible  in 
such  cases,  particularly  with  contracted  kidney.  To  my  mind,  we 
shall  have  to  follow  the  connection  of  nephritis  with  diseases  of  the 
eye  in  the  same  manner.  In  one  of  my  cases,  at  any  rate,  in  which 
the  patient  acquired  inflammation  of  the  choroid  and  retina  in  the 
course  of  nephritis,  the  simultaneous  inferiority  of  the  visual  ap- 
paratus seems  to  be  determined  by  congenital  lamellar  cataract. 

In  a  like  manner  I  think  the  acceptance  of  simultaneous  inferior- 
ity justified,  where  urinary  organs  and  digestive  apparatus  side  by 


AND    ITS    PSYCHICAL    COMPENSATION  53 

side  show  themselves  to  be  diseased.  Here  we  could  mention  al- 
buminuria  in  intestinal  affections,  nephritis  in  diabetes,  simultane- 
ous formation  of  stones  in  the  bile  duct  and  urinary  passage,  etc. 

In  affections  accompanying  pulmonary  tuberculosis,  phenomena 
of  simultaneous  inferiority  also  appear.  The  same  is  true  in  al- 
buminurias,  glycosurias,  strumas,  the  gastrointestinal  diseases  men- 
tioned before,  affections  of  the  heart,  lymphadenitis  and  certain 
skin  diseases.  If  we  accept  with  this,  primary  inferiority  of  the 
urinary  and  intestinal  apparatus,  of  the  skin  and  so  forth,  it  be- 
comes easily  comprehensible  that  under  certain  conditions  these  or- 
gans also  may  succumb  to  tuberculosis,  as  soon  as  an  opportunity 
for  infection  is  given. 

This  coordination  plays  a  large  part  in  relation  to  the  sexual 
apparatus  and  other  organs,  in  which  the  inferiority  of  both  is  often 
only  little  apparent  but  is  so  often  present  that  I  should  like  to  state 
that,  there  is  no  organ  inferiority  without  accompanying  inferi- 
ority of  the  sexual  apparatus.  This  view  is  made  probable  from 
the  outset,  by  the  appearance  of  heredity  in  the  study  of  inferior- 
ity. Since  now  the  hereditary  weakness  must  exist  in  the  sperma- 
tozoa and  ovule,  we  must  understand  that  the  place  of  development 
of  both,  in  a  wider  sense  the  whole  sexual  apparatus,  participates 
in  the  inferiority.  This  seems  to  me  to  be  a  fundamental  law  of 
the  theory  of  organ  inferiority,  namely,  that  every  organ  inferior- 
ity carries  its  heredity  through,  and  makes  itself  felt  by  reason 
of  an  accompanying  inferiority  in  the  sexual  apparatus.  For  the 
present  the  historic  origin  of  organ  inferiority  does  not  concern  us, 
the  hereditary  significance  of  which  could  evidently  first  appear 
in  connection  with  the  sexual  sphere.  The  acceptance  of  an  inter- 
nal secretion  of  the  genital  glands  scarcely  touches  our  argument. 
If  there  should  be  failure  of  secretion  or  hyper  function,  they  could 
only  act  on  other  organs,  according  to  the  degree  of  inferiority  of 
these  organs,  which  have  shown  themselves  as  inferior.  One  can 
only  get  an  unobscured  picture  of  such  organs  working  upon  each 
other  by  postulating  simultaneous  inferiority.  The  investigations 
in  this  group  will  have  an  enormous  field  to  compass.  Previous 
researches  which  are  not  directed  toward  our  point  of  view  of  simul- 
taneous inferiority,  exist  in  numbers  and  usually  only  require  fur- 
ther interpretation  in  our  sense.  This  is  the  case  in  the  connection 
of  anomalies  of  position,  flexions,  infantilism,  menstruation,  preg- 
nancy, climacteric  with  diseases  of  the  digestive  apparatus,  of  the 
blood,  the  kidney,  the  heart  and  the  lungs.  This  is  also  the  case 
in  the  obstinate  and  severe  course  of  diseases  of  the  sexual  or- 


54  STUDY  OF  ORGAN  INFERIORITY 

gans,  particularly  of  gonorrhea  and  its  complications,  in  connection 
with  the  inferiority,  which  can  be  demonstrated,  of  the  sexual  ap- 
paratus, but  also  of  the  urinary  organ,  the  lung  and  of  the  blood. 
Our  conception,  which  essentially  declares  the  frequency  of  simul- 
taneous inferiority  of  the  sexual  organs,  is  only  reinforced  by  the 
frequency  of  stigmata  and  of  tumor  formations  in  the  genitals. 
And  finally  the  whole  outcome  of  function  and  growth  of  the  sexual 
organs,  the  late,  but  then  too  full  development,  the  early  promise 
of  growth  and  function,  as  is  found  in  no  other  organ,  the  colossal 
growth  energy  and  power  of  regeneration  in  the  descendants,  gives 
in  dazzling  light  the  picture  of  the  phenomena  in  the  inferior  organ, 
just  as  we  have  previously  shown  it.  We  can  state  directly  that 
a  lesser  degree  of  inferiority  adheres  to  the  human  sexual  organ  in 
all  cases,  but  can  easily  take  on  larger  dimensions.  In  such  a 
case  those  characters  also  are  not  lacking  which  are  found  in  other 
inferior  organs,  such  as  heredity,  disease,  stigma,  childish  defects 
(early  masturbation)  and  reflex  anomalies. 

Further  inferiorities,  which  are  associated  with  sexual  inferior- 
ity, have  to  do  with  the  nose  (Fliess),  the  heart,  etc. 

The  strongest  opposition  which  our  conception  can  encounter 
seems  to  me  to  be  offered  by  the  simultaneous  falling  ill  of  two 
inferior  organs.  In  order  to  answer  this  question  accurately  a 
vast  amount  of  material  and  long  years  of  activity  in  that  experi- 
mental field  which  nature  has  formed  for  itself  in  the  enormous 
number  of  inferior  organs,  are  needed.  In  part  of  these  cases,  a 
disturbance  of  the  inner  secretion,  presumably,  in  case  of  disease  of 
the  one  organ  and  corresponding  weakening  and  disease  of  the  other 
inferior  organ,  can  be  accepted.  One  will  quarrel  just  as  little  with 
the  reflex  influence  which  the  disease  of  one  inferior  organ  trans- 
fers to  the  other,  particularly  if  one  remembers  that  to  the  inferior 
apparatus  there  corresponds  a  fundamentally  inferior  portion  of  the 
central  nervous  system,  which  later  becomes  greatly  over-compen- 
sated, and  thus  holds  a  dominating  position  both  physically  as  well 
as  psychically.  However  that  may  be,  I  should  like  to  touch  very 
forcibly  upon  the  fact  that  the  simultaneously  inferior  organs  seem 
to  be  bound  up  together  in  a  secret  alliance. 

This  and  that  secret  bond  can  be  shown  nowhere  else  with  such 
ease,  as  where  an  inferiority  of  the  related  portion  of  the  cen- 
tral nervous  system  is  associated  with  an  organ  inferiority.  This 
is  the  case  in  hypochondria,  hysteria,  anxiety  and  compulsion  neu- 
roses, as  we  shall  try  to  show  in  the  next  chapter.  It  would  be 
more  difficult  to  penetrate  into  the  relation  of  both  inferiorities 


AND   ITS    PSYCHICAL    COMPENSATION  55 

when  it  is  a  case  of  epilepsy  or  psychic  disease,  paranoia,  demen- 
tia, mania,  etc.  Psychoses  which  begin  coupled  with  intoxications, 
pyretic  diseases,  diabetes,  nephritis,  or  tuberculosis,  surely  belong 
in  the  framework  of  this  investigation,  just  as  do  the  often  empha- 
sized relations  between  epilepsy  on  the  one  hand  and  diseases  of  the 
intestinal  apparatus,  circulatory  or  urinary  organs  on  the  other. 

And  finally  I  should  like  to  say  that  the  discovery  of  one  or- 
gan inferiority,  considering  the  frequency  of  numerous  insufficien- 
cies, makes  it  our  duty  to  seek  for  further  inferior  organs. 


CHAPTER  VII 

THE  PART  PLAYED  BY  THE  CENTRAL  NERVOUS  SYSTEM  IN  THE 

THEORY  OF  ORGAN  INFERIORITY — PSYCHOGENESIS  AND 

FOUNDATIONS  OF  NEUROSES  AND  PSYCHONEUROSES 

Here  I  wish  to  add  a  few  considerations  which  are  almost  self- 
evident  from  our  studies.  We  shall  grasp  the  meaning  of  our  for- 
mer conception  only  if  we  exclude  neither  the  spinal  cord  nor  the 
brain  from  the  investigations  of  the  inferior  organ.  Indeed  it  must 
be  emphasized  that  the  simultaneous,  manifold,  organ  inferiority, 
already  characterized,  extends  itself  to  sectors  of  the  nerve  tracts 
of  the  central  nervous  system,  and  that  very  often  there  corresponds 
to  the  value  of  each  organ  a  naturally  proportionate  value  of  those 
nerve  tracts  that  conduct  to  them  their  stimulation  and  lead  from  them 
their  impulses.  To  be  sure,  one  cannot  expect  entirely  conformable 
behavior.  The  inferiority  may  remain  for  a  long  time  at  unchanged 
level,  and  may  also  be  confined  only  to  the  organ  or  parts  of  it, 
or  else  the  requirements  of  life,  domestication,  culture  produce  an 
over-compensation,  which  if  sufficient  will  make  its  way  particu- 
larly in  the  central  nervous  system.  The  quantitative  differences 
which  show  themselves  by  the  degree  of  inferiority,  by  the  local- 
ization, by  the  degree  of  compensation,  can  only  be  perceived 
as  qualitative  when  looked  at  from  the  psychologic  standpoint, 
a  fact  which  becomes  comprehensible  at  once  when  one  com- 
pares the  three  most  important  constellations  from  the  organic 
and  nerve  inferiority  field  with  their  results :  Degeneration,  neurosis, 
genius.  The  inferior  organs  incapable  of  compensation  fall  victims, 
under  the  influence  of  the  outside  world,  to  more  rapid  or  slower 
destruction.  On  the  other  hand  nature  forms  from  inferior  organs, 
under  the  influence  of  compensation,  apparatuses  of  more  variable 
function  and  morphology,  which  show  themselves  in  many  cases  to 
be  quite  capable  functionally  and  even  at  times  somewhat  better 
adapted  to  external  circumstances,  since  they  have  derived  their 
increase  in  strength  in  overcoming  these  external  obstacles  and 
have  consequently  stood  the  test.  Between  these  extremes  there 
are  still  mixed  formations  and  such  as  have  not  been  completely 
compensated,  whether  because  of  lack  of  reserve  strength  or  be- 

56 


STUDY  OF  ORGAN  INFERIORITY  57 

cause  of  premature  exhaustion  of  this  strength,  disturbance  of  com- 
pensation. Under  definite  conditions  the  cases  of  neuroses  and  psy- 
choneuroses  develop  from  this  group.  Some  important  facts  will 
be  touched  upon  in  the  following. 

Functional  and  morphologic  formation  of  the  organ  and  its 
nerve  tracks  will  make  the  inferior  material  functionally  capable, 
as  in  normal  development,  partly  as  a  result  of  stimulus,  partly 
owing  to  continued  effort.  Ordinarily  the  central  nervous  system  v 
will  play  the  largest  part  in  this  compensation.  And  not  only  phys- 
ically, say  by  particular  development  of  the  nerve  tracks,  associative 
fibers,  by  the  transformation  of  a  hereditary  lack  of  reflex  to  an  in- 
crease of  reflex  capability,  but  above  all  in  a  psychical  manner,  for 
the  reason  that  a  particular  interest  seeks  to  protect  the  inferior  «• 
organ  and  endeavors  to  ward  off  the  harm  by  constant  attention, 
and  the  psyche  on  a  small  scale,  perhaps,  gives  the  impulse  to 
awaken  the  attention,  to  increase  it  and  to  connect  it  with  that  organ. 

This  psychical  impulse  receives  further  support  as  soon  as  the 
inferior  organ  no  longer  follows  its  own  bent  but  has  to  bow  be- 
neath the  yoke  of  civilization.  How,  in  this  process,  organ* ;  in- 
stincts are  changed,  ennobled,  psychically  molded,  and  often  trans- 
formed to  their  polar  opposites — occurrences  which  are  grouped  by 
Freud  as  "  organic  repression" — shall  still  be  elucidated. 

Now  this  is  undoubtedly  overwork  as  compared  with  the  man- 
ner of  work  of  a  normally  valent  organ  and  will  clearly  appear  as 
such  in  childhood.  We  have  to  do  in  all  these  cases  with  the 
great  number  of  shy,  pale,  timid  children  whose  development  and 
future  can  only  be  considered  assured  when  they  have  learned  to 
manage  the  inferior  organ  without  injury,  in  other  words  when 
they  have  carried  out  the  compensation  and  can  function  without 
effort.  In  the  other  case,  if  the  performances  of  the  organs  are 
not  brought  about  by  a  surplus  from  the  central  nervous  system,  but 
at  the  expense  of  the  latter,  the  overwork  will  be  lastingly  felt  and 
on  suitable  occasions,  chance  causes  will  produce  a  disturbance  of 
compensation,  which  will  result,  according  to  the  degree  of  dis- 
turbance and  the  psychical  constellation  present  at  the  time  in  neu- 
rasthenia, anxiety  and  compulsion  neuroses,  and  hysteria. 

In  the  infantile  anomalies,  which  play  such  a  large  part  in  our 
work,  and  in  their  course,  inferiority  and  compensatory  efforts  must  v 
be  clearly  estimated.  Every  free  activity  of  the  infant  and  child 
is  connected  with  pleasure,  or  is  calculated  for  obtaining  pleasure, 
as  for  instance,  playing,  jumping,  running,  seeing,  hearing,  suck- 
ing, evacuation  of  feces  and  emptying  the  bladder.  The  pleasur- 


58  STUDY  OF  ORGAN  INFERIORITY 

able  sensations  derived  therefrom  form  properly  the  bond  by  means 
of  which  the  child  is  connected  with  his  surroundings,  socially  with 
the  outside  world.  They  are  directly  perceivable,  adhere  to  the  or- 
ganic activity,  and  their  traces  are  often  readily  discoverable  in 
later  life.  The  accentuation  of  pleasure  is  also  often  the  cause  of 
the  stubborness  of  children's  faults,  so  that  frequently  the  strength- 
ening of  the  child's  will,  or  the  suggestive  effect  of  some  therapeutic 
treatment  is  sufficient  to  do  away  with  the  fault.  In  the  psycho- 
analysis of  the  neuroses  Freud  has  demonstrated  this  primary 
pleasure  principle,  and  I,  too,  could  always  find  it  in  my  cases. 
This  fact,  moreover,  seems  convincing  to  me,  namely  that  I  found 
again  in  the  dreams  of  healthy  grown  people,  who  in  their  child- 
hood had  suffered  from  such  faults,  the  remembrance  of  such  pleas- 
urable sensations  in  the  form  of  wish-fulfilment  by  means  of  a 
dream.  This  was  the  case  in  dreams  of  such  people  who  had  suf- 
fered from  enuresis  in  their  childhood,  and  now  at  intervals  dreamed 
of  water,  of  swimming  or  of  fire. 

Approximately  normal  organs  with  a  corresponding  central  nerv- 
ous system  sufficiently  capable  of  assimilation,  adjust  themselves 
without  delay  to  the  requirements  of  surrounding  culture.  No  won- 
der, since  they  themselves  have  helped  in  building  up  and  direct- 
ing this  civilization.  On  the  other  hand,  changed  and  increased 
external  requirements,  disappointments,  cares,  traumatic  influences, 
diseases,  change  of  surroundings  may  show  up  an  organ  and  at  the 
same  time  its  central  superstructure  as  inferior  and  may  disturb 
its  compensation  which  is  with  difficulty  maintained  for  the  in- 
ferior organs  meet  with  difficulties  and  dangers  everywhere,  a  fact 
which  corresponds  to  their  natural  relation  to  their  surroundings, 
and  which  shows  the  real  basis  of  Darwin's  theory  of  natural  selec- 
tion. If  it  is  to  be  mastered,  this  must  be  done  with  heightened 

j  I  expenditure  of  strength.  Even  the  normal  organ  has  the  task  of 
subordinating  its  unrestricted,  pleasure-seeking  disposition  to  the 
compulsion  of  education.  The  nutritive  apparatus  may  only  find 
satisfaction  in  so  far  as  the  social  organization  and  the  great  aver- 
sions of  civilization  permit  it.  Thus  the  superior  psychic  realm  is 
forced  to  do  certain  tasks,  which  in  the  beginning  are  not  easy,  but 
which  on  the  average  undoubtedly  succeed  by  reason  of  the  height- 
ening of  the  functional  capability.  In  the  case  of  the  inferiority  of 
the  organ,  however,  and  the  corresponding  insufficiency  of  the 
related  portions  of  the  nervous  system,  the  participation  of  the 

-    organ  and  its  activity  in  the  demands  of  culture  remain  behind. 
The  function  then  does  not  follow  the  required  specified  cultural 


AND   ITS    PSYCHICAL    COMPENSATION  59 

paths  but  is  predominantly  engaged  with  seeking  pleasure.  We 
accordingly  find  in  the  development  of  the  normal  organ  a  certain 
subordination  of  the  pleasure  component  to  the  activities  called 
forth  by  the  environment — let  us  call  them  the  "  moral "  activities — 
the  final  success  of  which  ensures  the  child's  cultural  development. 
The  harmony  of  physical  and  psychical  functional  capability,  a 
psychophysical  parallelism  in  the  true  sense  of  the  word,  charac- 
terizes the  development  of  the  normal  child.  In  the  inferior  organ 
it  is  different.  If  there  is  a  particular  retardation  of  the  develop- 
ment of  the  organs,  as  well  as  of  the  related  nerve  tracks,  all  at- 
tempts at  culture  are  unsuccessful  and  conditions  such  as  idiocy  and  v 
imbecility  result.  But  in  milder  cases  also,  the  inferior  organ  turns 
spontaneously  to  gaining  its  desire,  averse  to  the  psychical  inter- 
ference, and  therefore  indulges  the  more,  the  longer  it  has  to  wait 
for  the  moral  redemption — Freud's  repression.  Since  in  the  mean-  v 
time  the  organ  has  become  accustomed  to  the  wanton  activity,  it 
will  now  accomplish  the  later  repression  against  greater  organic  op- 
position, and  introduce  a  lasting  struggle  which  will  be  felt  as  a 
torturing  compulsion.  These  conditions  may  be  most  clearly  seen 
in  the  cultural  development  of  emptying  the  bladder  and  evacua- 
tion of  the  feces.  Left  entirely  alone  these  functions  go  on  purely 
wantonly  in  the  infant  and  are  consequently  connected  with  sensory 
gratification  as  befits  every  instinctive  organic  function.  The  in- 
fluence of  the  surroundings  is  sufficient  to  place  the  function  of  the 
bladder  and  of  the  rectum  on  a  "moral"  basis  in  normal  organs 
and  in  normal  psychomotor  superstructures.  But  the  thing  which  I 
must  add  to  these  important  observations  of  Freud's  is  as  follows: 
The  childish  faults  are  only  the  externally  perceptible  phenomena 
arising  from  the  disturbed  psyche  and  mark  the  lack  of  an  adequate 
compensation  in  the  psychomotor  superstructure  of  the  organ.  Un- 
der normal  conditions  this  superstructure  is  influenced  by  the 
peripheral  stimulis  of  the  bladder,  of  the  rectum  and  likewise  of  the 
eye,  the  ear,  the  skin,  the  nutritive  and  respiratory  organs,  and  is  im- 
pelled to  continued  organic  growth,  and  to  this  there  corresponds — 
in  normally  developed  nerve  paths — a  psychic  development  suited 
to  the  environment.  Touching  the  inferior  organ,  however,  the 
parallelism  in  the  psychophysical  development  very  often  gives 
way  here  to  a  psychophysical  contrast.  The  psychomotor  super- 
structure of  the  inferior  organ  carries  on  a  continual  battle  against 
the  pleasure  activity  and  for  the  sake  of  the  "moral  mission"  of 
the  organ.  The  result  depends  on  the  capability  of  development  of 
the  fundamentally  inferior  superstructure,  on  the  congenital  growth 


6O  STUDY  OF  ORGAN  INFERIORITY 

energy  of  the  related  cerebral  cells  and  on  the  peripheral  stimuli 
reacting  on  the  same.  If  progress  is  to  result,  the  fundamental  infe- 
riority of  the  psychomotor  substance  must  be  compensated.  In 
another  place  we  have  pointed  out  that  this  compensation  often 
leads  to  over-value  of  the  organ,  and  finally  conclude  that  this  must 
e  by  means  of  over-valuation  of  the  psychomotor  superstructure. 

The  compensatory,  over-valuation  may  be  complete,  and  then 
the  increased  psychic  and  physical  relations  and  their  associations 
will  enrich  the  psyche  as  a  whole,  but  at  the  same  time  characterize  it. 
From  this  point  of  view  an  understanding  of  distinguished  and  genius- 
like  activities  is  possible,  and  at  the  same  time  a  conception  of  the 
v  prerequisites  which  very  often  lay  the  foundation  for  a  choice  of 
profession  or  a  particular  hobby  and  peculiarity.  I  have  already 
referred  to  the  degenerative  predisposition  of  Mozart's  ears,  to 
Beethoven's  otosclerosis,  to  the  stigmatizing  of  Bruckner's  ear  by 
a  nevus.  I  have  also  spoken  of  the  infantile  defect  in  Demos- 
thenes's  development  of  speech.  It  is  said  of  Moses,  the  orator  and 
leader  of  the  nations,  that  he  had  a  "heavy  tongue."  The  hal- 
lucinatory phenomena  in  Schumann's  psychosis  show  us  the  increase 
and  overcompensation  in  the  psychic  superstructure  of  the  ear,  but 
show  us  at  the  same  time,  even  as  every  hallucination  does,  the 
miscarriage  of  a  psychic  victory  and  of  psychophysic  harmony. 
Clara  Schumann  (B.  Litzmann,  "An  Artist's  Life  from  Diaries  and 
Letters"),  tells  of  her  childhood;  "This  woman  [the  maid  in 
whose  care  she  was]  simply  wasn't  talkative,  and  it  was  probably 
for  that  reason  that  I  only  began  to  say  disconnected  words  when 
I  was  between  four  and  five,  and  at  that  time  understood  just  as 
little."  And  in  another  extract :  ".  .  .  Since  I  heard  so  little  talking 
and  showed  so  little  interest  in  it  myself  .  .  .  my  parents  often 
complained,  particularly  as  I  began  to  speak,  that  I  did  not  hear 
well;  and  I  did  not  get  over  this  difficulty  until  about  my  eighth 
year,  although  it  improved  at  once,  the  more  I  began  to  talk  myself 
and  the  more  I  noticed  what  was  happening  around  me  and  to  me." 
Add  to  this  her  father's  remark :  "  This  is  the  opening  chord  of  an 
artist's  life,  which  in  its  course,  by  the  fullness  of  pure  melody 
which  it  bestowed  is  a  bringer  of  joy  of  a  rare  sort  to  countless 
people,  yes  even  more  than  this,  it  even  was  to  become  almost  a 
model  of  complete  and  purified  harmony  of  art  and  life.  It  begins 
with  a  harsh  discord."  One  of  our  best-known  piano  virtuosos, 
R.  B.,  suffered  in  his  childhood  from  purulent  otitis  media  and 
perforation  of  the  ear  drum  in  both  ears. 

I  have  already  mentioned  the  tokens  of  degeneration,  childish 


AND   ITS    PSYCHICAL    COMPENSATION  6l 

defects,  reflex  anomalies,  in  speakers,  singers,  and  actors.  These  * 
tokens,  as  well  as  the  frequent  diseases  of  the  respiratory  tract  of 
such  persons  or  in  their  families,  lead  us  to  conclude  definitely  a 
fundamental  inferiority  of  the  respiratory  apparatus  and  consecu-  -' 
tive  over-compensation  in  the  related  psychic  field.  The  same  is 
true  of  cooks  and  gourmands,  a  fact  which  I  have  emphasized  in 
another  place.  I  must,  however,  call  your  attention  to  the  fact 
that  in  these  people  the  frequent  gastro-intestinal  diseases  as  well 
as  the  poor  teeth,  surely  do  not  originate  from  hot  or  biting  food, 
but  rest  upon  the  inferiority  of  the  nutritive  organs.  Thus  for  in- 
stance the  ulcus  rotundum,  whose  tendency  to  recurring  and  car- 
cinomatous  transformation  can  be  first  understood  from  this  point 
of  view.  We  find  similar  conditions  in  painters  as  in  musicians. 
I  shall  not  speak  of  individual  cases,  such  as  Lenbach  and  several 
artists  whom  I  know.  But  the  optical  examinations  recently  insti- 
tuted in  schools  of  art  show  optical  anomalies  in  70  per  cent,  of  the 
students. 

These  are  the  results,  when  considering  the  successful  cases 
of  over-compensation,  which  are  evidently  sufficient  to  explain 
and  correct  Lombroso's  mistakes.  But  what  happens  when  the 
compensation  is  not  successful,  when  the  psychic  impulse  arising 
from  physical  need — on  the  one  hand  insufficiency  of  the  organ, 
on  the  other  pressure  of  life  and  culture — meets  with  more  unser- 
viceable brain  material,  when  the  compensatory  activities  only  get 
half  way?  A  condition  of  high  psychic  tension  must  naturally 
arise  from  these  psychophysical  relations,  which  causes  those  per- 
sons who  undergo  such  tension  to  be  no  longer  capable  of  contend- 
ing with  any  sort  of  heightened  requirements.  They  suffer  incon- 
tinence of  urine  and  involuntary  defecation  at  the  slightest  difficul- 
ties in  human  life,  at  tests,  with  fright  and  excitement,  and  return 
to  one  of  those  infantile  anomalies  which  they  have  with  difficulty 
conquered  and  which,  as  I  have  already  shown,  represent  continua- 
tions and  further  developments  of  heightened  reflex  manifestations. 
They  stammer,  vomit,  laugh,  cry,  scratch  themselves,  tear  their 
hair,  start,  blink  or  have  violent  attacks  of  spasmodic  sneezing  upon 
seeing  a  bright  light,  squint  when  looking  at  anything  close  at  hand, 
etc.  All  these  phenomena  are  too  well  known  individually  for  me 
to  have  to  prove  them  by  means  of  illustrative  cases. 

The  mastering  of  children's  defects  then,  and  all  the  difficulties 
which  arise  from  the  inferior  organ,  point  to  compensatory  activ- 
ities in  the  superstructure  and  if  hitherto  the  childish  defects  were 
external  tokens  of  organ  inferiority,  it  now  appears  that  they  really 


62  STUDY   OF   ORGAN    INFERIORITY 

represent — like  Chladny's  tone  figures — lines  of  direction  from  the 
life  of  the  psyche,  and  are  signals  which  indicate  the  peripheral 
and  central  inferiority  which  has  not  yet  been  successfully  overcome. 

In  regard  to  reflex  anomalies  in  the  inferior  organ  I  can  still 
add  that  the  deficient  reflex  may  get  its  psychic  contrast  by  reason 
of  the  compensatory  growth  of  the  related  psychomotor  zone,  so 
that  if,  for  instance,  the  palatal  reflex  is  lacking,  an  excitement  will, 
however,  bring  retching  and  vomiting  with  it.  This  state  of  af- 
fairs is  not  rare ;  I  shall  cite  a  few  cases,  because  it  seems  hitherto 
to  have  escaped  the  notice  of  neurologists. 

Eugenie  /.,  46  years  old,  a  teacher,  unmarried,  was  one  day 
addressed  in  cutting  terms  by  her  brother.  At  night  she  dreams  that 
her  brother  is  burning  out  her  throat  with  a  candle,  awakens  in 
terror,  bathed  in  perspiration,  feels  violent  pressure  and  burning 
in  the  pharynx,  in  the  larynx  and  in  her  mouth.  She  struggles  for 
breath,  thinks  she  has  lost  her  mind,  and  tries  to  determine  whether 
gas  has  been  escaping  in  the  room.  At  the  same  time  she  vomits 
a  greenish  colored  watery  fluid  several  times.  Admits  that  she 
almost  always  vomits  when  excited.  The  examination  shows  nor- 
mal conditions,  except  for  a  small  umbilical  hernia,  which  has  always 
been  the  cause  of  hypochondriacal  paroxysms,  and  complete  lack 
of  palatal  and  pharyngeal  reflexes.  The  tongue  is  not  coated,  no 
nausea  in  the  morning,  stomach  not  sensitive  to  pressure,  appetite 
normal.  From  the  early  history  we  only  find  that  the  patient  was 
a  weakly  child  who  did  not  eat  well,  who  suffered  a  great  deal 
from  heartburn,  singultus  and  vomiting  during  puberty.  Accord- 
ing to  this  material  we  find  it  to  be  a  case  of  inferiority  of  the  nutri- 
tive tract  (umbilical  hernia,  reflex  anomalies,  anamnesis),  which 
is  adjusted  by  over-compensation  in  the  psychomotor  superstruc- 
ture— vomiting  only  appears  now  upon  a  psychic  disturbance  of 
equilibrium.  The  patient  has  been  inclined  to  corpulence  since  her 
twentieth  year. 

Julius  P.,  a  merchant,  45  years  old,  vomits  if  he  sees  a  hair  or  a 
fly  near  any  food,  and  at  times  even  if  he  thinks  of  it ;  occasionally 
also  in  consequence  of  a  vexatious  occurrence.  In  his  youth  he  was 
almost  free  from  feelings  of  nausea,  and  would,  without  thinking, 
put  the  most  atrocious  things  into  his  mouth.  Later  he  became  an 
epicure  and  heavy  eater  and  transformed  himself  from  a  slender 
youth  into  a  corpulent  man  (230  Ibs.).  Very  characteristic  is  a 
dream  which  keeps  recurring  in  the  same  form,  in  which  some  one 
keeps  constantly  stuffing  a  loathsome  mass  into  his  mouth,  so  that 
he  is  in  danger  of  choking  and  awakens  in  terror.  One  of  his  sons 


AND   ITS    PSYCHICAL    COMPENSATION  63 

had  enuresis  and  involuntary  defecation  until  he  was  15  years  old. 
Palatal  reflex  lacking,  pharyngeal  reflex  greatly  diminished.  Here 
also  we  find  over-compensated  inferiority  of  the  nutritive  tract  with 
diminished  peripheral  and  increased  central  reflex  ability. 

Anna  W .,  28  years  old,  married,  vomits  at  the  slightest  excite- 
ment. No  palatal  reflex.  One  brother  was  an  enuretic  until  his 
eighth  year  and  suffered  from  involuntary  evacuation  of  feces. 
The  patient's  father,  54  years  old,  has,  ostensibly,  always  suffered 
from  constipation.  Here  also  we  find  the  inferiority  of  the  nutritive 
tract  stamped  in  a  different  manner  upon  the  family,  while  in  the 
patient  herself  there  is  heightened  central  reflex  as  a  token  of  the 
over-compensation. 

The  phenomenology  of  the  successful  as  well  as  the  unsuccessful 
over-compensation  will  show  the  same  fundamental  traits,  the  same 
internal  structure,  even  though  it  differs  externally  from  that  of  the 
normal  cerebral  development.  We  can  always  find  among  the 
achievements  of  the  central  superstructure  related  to  the  organ  the 
following:  Attentiveness,  proportionately  distributed  and  in  corre- 
spondence with  the  organic  relation  with  the  outer  world  directed 
upon  the  surroundings  on  the  part  of  the  normal  organ,  dispropor- 
tionately distributed  and  increased  according  to  the  organic  over- 
compensation  in  the  inferior  organ,  more  easily  aroused,  but  less  < 
productive  by  reason  of  unsuccessful  compensation,  insufficient  or 
else  not  present  at  all  in  cases  of  lasting  central  inferiority.  Even 
in  this  psychical  phenomenon  we  again  find  the  differences  which 
have  for  long  been  considered  as  determinative  in  judging  the 
normal  brain  and  the  neurosis  or  psychoneurosis,  the  establishment 
of  which,  however,  can  only  occur  with  the  acceptance  of  the  theory 
of  organ  inferiority.  In  anticipation  we  will  emphasize  at  this  point 
the  fact  that  this  work  aims  to  refer  all  phenomena  of  neuroses  and 
psychoneuroses  back  to  organ  inferiority,  to  the  degree  and  nature 
of  the  not  quite  successful  central  compensation  and  to  compensa- 
tory disturbances  which  enter  into  the  matter. 

Organic  nerve  diseases,  however,  are  according  to  our  premises 
only  special  cases  in  which  the  localized  inferiority  is  inclined  to  in- 
flammatory or  degenerative  transformations ;  the  combinations  of 
organic  and  functional  affections,  typical  of  many  clinical  pictures, 
appears  as  a  necessary  coordination.  The  influence  of  psychic  and 
hypnotic  therapy  can  accordingly  be  easily  understood.  A  few  fur- 
ther citations,  relating  to  the  difference  between  normal  psychic 
development  and  that  resting  upon  over-compensation,  have  to  do 
with  recollection  and  memory.  One  can  not  however  at  the  same 


64  STUDY  OF  ORGAN  INFERIORITY 

time  lose  sight  of  the  fact  that  these  conceptions  characterize  for  us 
the  symbolic  in  the  web  of  the  psyche  and  that  the  occurrences  at 
its  basis  have  a  psychic  continuity  and  psychic  connection  with  other 
occurrences,  such  as  perception,  judgment  and  volitional  processes. 
But  their  connection  is  just  as  certain  with  the  external  perceiving 
and  executive  organs,  the  relation  of  which  to  the  surroundings  de- 
termines the  manner  and  content  of  all  central  occurrences.  Thus 
one  can  declare  that  every  organ  has  a  right  to  its  recollection,  its 
memory  in  the  central  psychomotor  superstructure,  as  a  function  of 
this  psychical  field.  In  regard  to  the  inferior  organ,  functional  in- 
creases are  found  upon  the  entrance  of  central  compensation  or  over- 
compensation,  one  of  which  may  become  noticeable  as  increased 
recollective  ability.  Among  the  number  of  memory  pictures  those 
will  predominate  in  strength  and  number  which  belong  to  the  in- 
ferior organ  in  respect  to  its  over-compensated  psychic  field. 

It  corresponds  only  to  the  special  form  of  our  civilization  and 
its  reflection  in  the  human  psyche,  that  the  eye,  ear  and  organs  of 
speech  are  held  to  special  activities  and  according  to  this  acquire 
very  special  development  of  their  psychic  superstructure  even  in 
the  normal.  Wherever  compensation  or  over-compensation  enters, 
the  memory  activities  belonging  to  the  organic  superstructure  are 
heightened,  but  are  also  subject  to  all  the  dangers  which  threaten 
the  increased  growth  of  inferior  portions  of  an  organ,  such  as  dis- 
turbances of  compensation  in  the  form  of  weakness  of  memory, 
amnesia,  an  increase  in  particularly  stressed  memories,  associative 
strengthening,  etc. 

I  can  not  go  any  further  into  detail  at  this  point.  A  similar 
point  of  view  is  at  the  basis  of  the  development  of  critical  ability 
in  the  superstructure  of  the  inferior  organ,  increased  power  of  in- 
trospection, inspiration,  intuition  and  the  comprehension  of  the 
genius,  the  building  up  of  hallucinatory  characters  in  the  psyche, 
the  development  of  the  abnormal  idea  on  the  basis  of  compensatory 
activity,  which  also  affects  the  function  of  the  will  and  the  percep- 
tion of  pleasure  and  displeasure,  etc.  From  the  motor  portion  of 
the  compensating  superstructure  arise  all  phenomena  of  the  neu- 
roses, which  are  of  importance  as  motor  discharges,  such  as  tic, 
forms  of  paralysis  and  hysterical  cramps  and  paralysis,  epilepsy, 
etc.,  whose  whole  clinical  picture  owes  its  origin  to  the  actual  con- 
stellation in  the  psychomotor  superstructure,  and  which  is  less  con- 
nected with  the  compensatory  advancement  of  the  reflex  mechanism. 
The  occupation  cramps,  writer's  cramp,  etc.,  may  be  classed  here  as 
compensatory  disturbances. 


AND   ITS    PSYCHICAL    COMPENSATION  65 

In  the  infantile  anomalies  to  which  are  ascribed  masturbation 
characteristics,  sucking  the  thumb,  sucking  the  lips,  tickling  the 
skin,  touching  the  anus  and  actual  early  masturbation,  we  can  again 
observe  the  wanton  inclination  aimed  at  the  obtaining  of  pleasure, 
which  is  peculiar  to  the  inferior  organ,  the  mouth,  intestine,  gen- 
itals. The  same  thing  is  true  of  nocturnal  enuresis.  If  we  now 
remember  that  all  inferior  organs  are  perhaps  regularly  accom- 
panied by  inferior  sexual  organs,  in  which  the  inclination  for 
pleasure  is  likewise  present  in  a  marked  degree,  if  we  admit  that 
almost  all  the  children  burdened  with  childish  defects  also  engage  in 
masturbatory  touching  of  the  genitals,  we  must  establish  as  a  result 
of  this  consideration  the  fact  that  the  possession  of  inferior  organs 
can  very  easily  lead  to  sexual  precocity,  to  early  masturbation. 

If  this  distinguishing  feature  has  appeared,  there  are  at  least  two 
dominating  cerebral  portions  which  undergo  heightened  growth 
stimulus  and  heightened  psychic  impulsion,  and  one  of  these  builds 
itself  up  over  the  inferior  sexual  apparatus.  It  is  quite  compre- 
hensible that  both  the  psychic  fields  should  be  associatively  con- 
nected, very  like  the  audition  coloree  which  also  owes  its  origin  to 
the  compensatory  superstructure  of  two  inferior  organs.  In  this 
manner  psychic  groupings  arise  very  early,  groupings  which  have 
been  formed  fundamentally,  of  two  sorts  of  impressions:  on  the 
one  hand  from  the  world  of  sexual  sensibility  and  ideas,  on  the 
other  from  the  psychic  superstructure  of  the  eye,  ear,  mouth,  ex- 
cretory organs,  skin,  nose.  In  all  these  cases  the  fate  of  the  psyche 
as  a  whole  depends  upon  the  complete  or  incomplete  mastery  and 
balancing  of  the  two  corresponding  inferiorities,  the  central  and 
peripheral  inferiorities ;  the  fate  of  the  patient,  then,  is  at  the  mercy 
of  the  complete  or  incomplete  compensation,  of  the  lasting  or  inter- 
rupted compensation.  But  the  prospect  becomes  much  more  diffi- 
cult as  soon  as  the  sexual  components  enter  the  question  and  touch 
upon  and  influence  the  other  psychic  superstructure.  The  com- 
pensation may  then  be  a  universal  one;  it  may  however  only  have 
developed  in  one  or  in  neither  of  the  psychomotor  fields.  We  can 
not  dwell  here  on  how  it  affects  individual  cases,  in  the  various 
psychoneuroses.  Only,  I  must  state  that  the  interesting  psychic 
phenomena  of  repression,  substitution,  conversion,  which  Freud 
demonstrated  in  his  psychoanalyses  and  which  I  also  found  to  be 
the  most  important  constituents  of  the  psychoneuroses,  develop 
upon  the  above-described  formation  of  the  psyche  in  the  case  of  in- 
ferior organs.  In  a  like  manner  the  usual  statement  of  "  sexual 
basis "  of  psychoneuroses  is  cleared  up  by  the  above.  Complete 


66  STUDY  OF  ORGAN  INFERIORITY 

compensation  such  as  we  find  in  artists,  geniuses,  a  few  profes- 
sional people,  has  a  great  many  psychic  functional  characteristics  in 
common  with  the  psychoneuroses,  and  has  with  many,  especially 
with  hysteria,  a  common  culmination  point,  the  hallucinatory  char- 
acter of  the  psyche. 

The  following  quotations  from  "  Grimm's  German  Mythology  " 
bears  witness  how  closely  our  conception  of  the  compensation  and 
over-compensation  of  the  inferior  organ  corresponds  to  the  popu- 
lar feeling: 

"We  find  in  the  heroes  as  well  as  in  the  Gods  want  of  limbs: 
Orin  is  one-eyed,  Tyr  one-handed,  Loki  [  ?  =  Haphsestus]  lame, 
Hoeder  blind,  Vidar  dumb,  Hagano  also  one-eyed,  Walkeri  one- 
handed,  Gunther  and  Wieland  lame;  and  there  are  a  goodly  num- 
ber of  blind  and  dumb  heroes.  But  it  seems  heroic  that  while  a  de- 
fect disfigures  childhood  and  early  youth  suddently  from  out  such 
gloom  appears  the  radiant  presence  as  well  as  the  power  long  curbed. 
To  these  belong  the  blind  birth  of  the  Guelph  and  the  folk-tradition 
birth  of  the  Hessian  and  the  Suabian." 


CHAPTER  VIII 
BIOLOGICAL  VIEWPOINT  IN  THE  ORGAN  INFERIORITY  THEORY 

The  inferior  organ  gets  its  most  distinct  imprint  in  the  phenom- 
enon of  congenital  deformity.  The  nature  of  the  inferiority  is 
shown  almost  as  clearly  in  the  external  stigmata.  The  connections 
of  other  tokens  of  inferiority  with  both  of  these  have  been  so  clearly 
pointed  out,  in  this  work,  that  the  conclusion  is  evident:  The  in- 
feriority of  the  organ  is  embryonic  in  origin. 

The  variability,  the  growth  energy,  and  compensatory  ability 
have  likewise  been  strongly  enough  emphasized.  These  are  what 
guarantee  the  possibility  of  an  adjustment,  provided  that  the  vital 
capacity  and  duration  of  life  do  not  seem  to  be  threatened  by  the 
fundamental  check  in  growth, — provided,  furthermore,  that  the 
drawing  in  of  reserve  strength  does  not  meet  with  too  great  a  hin- 
drance. The  final  result  of  the  struggle  for  the  existence  of  the 
organ  arises  from  the  relation  between  the  existing,  structurally 
capable  material,  and  the  required  work.  The  efforts  at  growth 
which  come  to  light  in  this  process  and  the  results  are  not  to  be 
compared  with  those  of  normal  organs.  They  bring  before  our  eyes, 
rather,  a  portion  of  that  strength  which  expresses  itself  in  the  live- 
liness and  variability  of  embryonic  growth.  A  second  assumption 
is  justified  by  this :  Namely,  that  the  inferior  organ  bears  with  it  in 
morphology  and  function,  its  embryonic  characteristics. 

By  analogy  from  the  causes  of  deformities,  the  following  out- 
line of  the  causes  of  organ  inferiority  can  be  drawn  up: 

1.  Primary  lack  of  formative  material.     In  this  we  can  observe 
particularly  well  the  familiar  appearance,  or  can  find  exhausting 
diseases,  lues,  alcoholism,  poisoning  of  the  parents  at  the  time  of 
procreation.     In  the  latter  case,  nevertheless,  the  selection  of  the 
organ  will  frequently  be  further  determined  by  its  own  primary  in- 
feriority. 

2.  Inflammatory  processes  during  the  embryonic  development, 
by  which  again  the  selection  of  the  organ  can  not  occur  without 
determination. 

3.  Disturbing  influence  of  a  neighboring  organ  in  the   foetal 
period.     In  this  case  also  a  dispositional  cause  must  be  sought  for 
the  injurious  cooperation. 

67 


68  STUDY   OF   ORGAN    INFERIORITY 

If  we  wish,  from  the  point  of  view  now  won,  to  attain  a  uniform 
perspective  of  the  inferiority  of  organs,  we  must  turn  our  attention 
to  the  embryonic  formative  material  and  its  destiny.  The  inferi- 
ority which  we  are  discussing  here  never  occurs  as  a  result,  but 
always  as  a  preliminary  condition,  and  is  the  one  which  people 
have  usually  tried  to  class  with  the  confused  idea  of  disposition. 
The  incompleteness  in  this  type  of  organs,  the  cessation  of  develop- 
ment which  can  often  be  found  in  them,  the  lack  of  development  in 
a  histologic  or  functional  direction,  the  functional  deficiency  in  the 
postfetal  stage,  and  on  the  other  hand  the  increase  in  its  growth 
tendency  owing  to  compulsion  of  compensation,  and  possibility  of 
compensation,  the  frequent  success  in  gaining  greater  functional 
ability,  force  us  to  accept  the  fact  that  all  inferior  organs  have  a 
part  of  the  fetal  characteristics.  With  the  breaking  away  from 
the  maternal  organism  the  struggle  with  the  outer  world  begins  for 
these  organs  and  organic  systems,  a  struggle  which  must  of  neces- 
sity be  kindled,  and  which  begins  with  greater  violence  than  in  a 
normally  developed  apparatus.  Higher  rates  of  disease  and  mor- 
tality accompany  this  struggle.  Nevertheless  the  fetal  character 
supplies  at  the  same  time  the  heightened  possibility  of  compensa- 
tion and  over-compensation,  increases  the  ability  of  adaptation  to 
usual  and  unusual  resistance  and  assures  the  formation  of  new  and 
higher  forms,  of  new  and  higher  execution.  One  easily  gets  the 
impression  that  the  organism  has  economized  in  the  fetal  develop- 
ment, that  it  arrested  the  embryonic  maturity  at  a  certain  place, 
in  order  to  give  the  organ  a  means  of  maintaining  itself  for  life, 
a  heightened  formative  power.  And  one  can  scarcely  dispose  of  the 
conception  that  this  new  formative  attempt  is  undertaken  in  those 
organs  in  which  a  series  of  ancestors,  owing  to  external  causes,  to 
changed  living  conditions,  have  suffered  injury  during  their  lives. 
Thus  the  inferior  organ  presents  the  inexhaustible  trial  material, 
by  means  of  the  constant  working  over,  repudiation,  improvement  of 
which,  the  organism  seeks  to  come  into  harmony  with  the  changed 
conditions  of  living. 

The  struggle  with  the  hostile  influences  of  life  very  often  threaten 
the  possessors  of  inferior  organs  with  disease  and  death,  even  if 
they  can  enter  the  world  as  viable.  Terrible  and  terrifying  as 
are  the  demands  of  this  hecatomb,  it  nevertheless  hinders  the  un- 
restricted spread  of  inferior  formative  material  of  humanity,  if  one 
considers  a  fairly  long  stretch  of  time.  If,  however,  on  the  one 
hand  inferior  organs  incapable  of  compensation  meet  with  more 
rapid  or  slower  destruction  under  the  pressure  of  the  outside  world, 


AND   ITS    PSYCHICAL    COMPENSATION  69 

nature,  on  the  other  hand,  by  the  creation  of  a  compensation,  forms 
apparatuses  of  variable  function  and  morphology,  which  prove  them- 
selves in  many  cases  to  be  quite  functionally  capable  and  somewhat 
better  adapted  to  external  conditions,  since  they  have  drawn  their 
additional  strength  from  the  overcoming  of  these  external  obstacles. 
The  organ's  abnormality  is  deeply  rooted  in  the  constraint  of  a 
fixed  training,  in  the  variability  and  greater  tendency  to  growth 
which  often  adhere  to  an  inferior  organ,  and  in  the  development 
of  the  related  nervous  and  psychic  complexes  heightened  by  the 
inner  attention  and  concentration.  The  adaptation  to  altered  con- 
ditions of  living  takes  place  preeminently,  not  in  a  struggle  for 
existence  by  the  survival  of  the  accidentally  stronger,  but  on  the 
basis  of  variability  and  heightened  growth  tendency  of  inferior 
organs. 

We  have  proposed  heredity  as  one  of  the  most  important  indica- 
tions of  inferior  organs  and  have  tried  to  make  this  relation  compre- 
hensible through  the  phenomenon  of  simultaneous  inferiority  of  the 
sexual  apparatus.  Among  the  possibilities  of  explanation  of  this 
phenomenon,  the  foremost  place  might  be  given  to  one  which 
reckons  with  the  additional  work  to  be  accomplished  by  the  inferior 
organ,  so  that  a  vigorous  demand  on  the  organ  would  correspond 
to  a  check  on  the  embryonic  equivalents  in  the  genital  glands.  Be- 
sides not  everything  which  is  classed  as  an  acquired  characteristic  is 
entirely  unconnected  with  the  inferior  organ.  On  the  contrary  we 
can  assume  that  the  most  effective  changes  and  injuries  take  place 
in  the  inferior  organ,  the  heredity  of  which,  their  embryonic  plas- 
ticity and  variable  character,  is  beyond  doubt. 

The  reference  to  the  whole  organic  world  follows  of  itself.  And 
in  this  the  theory  of  organ  inferiority  seems  to  broaden  and  sup- 
port the  theory  of  heredity  in  its  most  important  features. 


APPENDIX 

THE  INFERIORITY  OF  THE  URINARY  APPARATUS. — FATE  OF 
ENURETICS  AND  THEIR  FAMILIES 

At  the  beginning  of  this  work  there  are  a  few  considerations  con- 
cerning diseases  of  the  urinary  organs,  in  the  pursuance  and  expansion 
of  which  cases,  we  were  led  to  establish  the  organ  inferiority  theory 
as  the  basis  of  a  particular  conception  of  pathology.  If  at  the  end 
an  attempt  is  to  be  made  from  the  illustrative  cases  of  a  single  organ, 
again  the  urinary  apparatus,  to  make  clear  the  value  and  extent  of 
the  theory  of  inferiority,  to  confirm  already  known  connections,  to 
uncover  new  ones,  I  believe  that  I  can  best  overcome  the  great  diffi- 
culties of  such  a  task  if  I  only  choose  cases  which  can  be  arranged 
according  to  a  single,  and  at  all  events  distinct,  point  of  view,  those 
that  have  one  symptom  of  inferiority  in  common  either  themselves 
or  in  the  family,  the  symptom  of  the  childish  defect,  namely, 
enuresis. 

A  vast  amount  of  material,  but  only  partly  valuable,  may  be 
found  in  the  literature  about  enuresis,  its  nature  and  its  pathogenic 
position.  I,  myself  have  emphasized  a  few  of  its  important  facts 
in  this  study.3  At  this  point  I  must  confine  myself  to  carrying 
through  the  centering  of  the  phenomena  of  inferiority  of  the  urinary 
apparatus  upon  enuresis,  and  to  emphasizing  the  simultaneous  in- 
feriority of  the  central  nervous  system  and  of  the  sexual  apparatus 
and  to  illustrate  this  with  cases.  In  this  I  shall  follow  the  schematic 
outline  of  my  study  and  I  hope  that  the  reader  will  find  the  general 
conformity  to  tradition  which  was  followed  there,  again  in  this. 

This  will  be  the  case  in  diseases  of  the  urinary  apparatus,  whether 
it  is  in  the  enuretic  himself  or  in  his  family.  We  may  expect  all 
the  genuine  diseases,  in  the  prostate,  the  bladder,  the  ureters,  the 
kidneys  and  the  urethra.  We  will  however  also  find  localization  of 
disease,  congenital  anomalies,  a  particular  and  usually  difficult  course 
of  infection  and  functional  affections.  I  should  like  to  stress  as 
particularly  interesting  facts  in  my  material,  carcinoma  of  the  uri- 
nary apparatus,  contracted  kidney,  scarlet  fever  nephritis  and 
difficult  course  of  gonorrhea  in  enuretics  or  in  their  families. 

3  I  shall  give  a  short  exposition  on  these  child  errors  in  the  "  Illustrierten 
medizinischen  Handlexikon  "  [edited  by  Dr.  Max  Kahane,  Urban  &  Schwar- 
zenberg,  publishers,  Vienna-Berlin],  which  is  coming  out  shortly. 

70 


STUDY  OF  ORGAN  INFERIORITY  71 

The  second  indication  of  inferiority,  heredity,  is  already  strik- 
ingly noticeable  in  enuresis  itself.  No  less  noticeable  however  in 
its  appearance  in  every  imaginable  affection,  anomalies  and  stigmata 
in  any  portion  of  the  urinary  apparatus,  as  has  already  been  empha- 
sized in  the  preceding  pages. 

We  shall  frequently  meet  with  signs  of  the  degenerations  also 
quite  often  falsely  called  the  causes  of  enuresis,  as  peripheral 
phenomena  of  inferiority  of  the  urinary  apparatus.  At  any  rate 
we  find  it  in  the  sexual  organ,  which  is  almost  always  found  to  be 
included  in  the  inferiority. 

In  regard  to  reflex  anomalies  we  must  refer  to  spasm  of  the 
sphincter,  which  one  often  meets  with  in  people  who  have  been 
enuretics.  Almost  as  often  do  we  find,  on  sounding  the  urethra,  a 
relaxed,  unreacting  sphincter  externus,  both  of  which  are  anomalies, 
as  we  have  emphasized  in  the  discussion  of  the  palatal  reflex. 
Freud's  symptom  in  many  cases  of  enuresis,  adductor  cramp  of  the 
thigh  on  suddenly  pulling  the  latter  out,  arises  from  the  extension 
of  the  reflex  zone  of  the  sphincter  and  is  analogous  to  the  move- 
ment of  choking  in  cases  of  increased  pharyngeal  reflex,  which  in 
some  cases  sometimes  even  takes  place  by  pushing  the  spatula  back 
of  the  teeth.  Here  we  must  mention  also  inability  to  urinate  in  the 
presence  of  others,  shivering  and  rigor  while  urinating,  functional 
dysuria,  retention  of  the  urine  and  polyuria,  which  one  often  finds 
in  those  who  have  been  enuretics,  or  in  their  families. 

I  must  lay  very  great  stress  on  segmental  inferiority  in  enuretics. 
Not  so  much  the  skin  anomalies,  which  are  often  found  as  nevi  or 
neurofibromata  at  about  the  height  of  the  kidney,  in  the  region  of 
the  bladder  or  in  the  groin,  but  an  inferiority  which  often  has  to 
do  with  the  whole  rear  portion  of  the  body  and  comes  into  con- 
sideration as  primary  weakness  in  voiding  of  the  urine,  evacuation 
of  the  bowels  and  emission  of  the  semen,  which  can  often  be  over- 
come, and  even  over-compensated  and  is  evidently  connected  with  an 
inferiority  of  the  spinal  cord  from  the  lumbar  vertebrae  downwards. 
It  is  not  a  rare  thing  to  find  the  lower  extremities  also  involved  in 
this  inferiority.  This  relation  is  of  importance  in  regard  to  the 
problem  of  tabes,  sciatica,  and  incontinence  of  the  bowels  in  the 
families  of  enuretics.  The  spinal  column  also  takes  part  in  it  with 
indications  of  spina  bifida  or  deformity,  and  the  lower  extremities 
with  deformities,  disproportionate  legs  or  diseases  of  the  joints. 

As  to  what  concerns  the  simultaneous  inferiority  of  other 
organs,  particularly  of  the  sexual  organs,  the  material  prescribed  will 
evidence.  In  the  literature  we  find  congenital  displacement  of  the 


72  STUDY   OF   ORGAN    INFERIORITY 

testicles  mentioned  most  often,  which  I  also  often  found,  and  then 
perhaps,  phimosis,  hypospadia  and  adhesion  of  prepuce  and  glans 
penis,  if  one  wishes  to  consider  these  as  tokens  of  inferiority  of  the 
sexual  organs.  More  significant  for  my  assumptions  are  the  cases 
of  formation  of  tumors  in  the  sexual  organs,  such  as  an  enuretic 
family  shows,  and  the  almost  invariably  demonstrable  anomalies  in 
sexual  intercourse,  above  all  ejaculatio  precox.  Strikingly  often  the 
mothers  in  enuretic  families  die  during  or  after  a  birth,  and  one 
often  finds  enuretics  as  step-children.  From  my  material  it  appears 
that  inferiority  diseases  of  the  sexual  organs  or  of  the  kidneys  may 
occasion  such  early  death,  while  other  such  mothers,  by  reason  of 
a  difficult  birth  (pelvic  anomalies,  as  segmental  inferiority),  or  by 
reason  of  injuries  during  one  of  the  first  pregnancies  guard  them- 
selves from  danger  to  their  lives  in  case  of  another  pregnancy.  In 
other  cases  conception  does  not  take  place  or  else  repeated  mis- 
carriages prevent  maternity.  One  then  usually  finds  as  a  cause 
uterine  myoma,  renal  disease,  or  infantilism  of  the  uterus  (narrow- 
ness of  the  orifice). 

The  relation  of  enuresis  to  the  central  nervous  system  and  to  the 
psyche  is  adhered  to  to  a  certain  degree  in  the  literature,  without 
much  weight  given  to  the  relations  which  have  here  been  revealed. 
Freud,  who  has  advanced  the  furthest,  emphasized  the  significance 
of  infantile  enuresis  in  dream  and  neurosis.  The  Breslau  School 
and  many  others  with  it  consider,  on  the  contrary,  that  enuresis  is 
an  hysterical  symptom.  Desire  for  urination  and  incontinence  from 
excessive  psychic  strain,  in  laughing  and  crying  (Bechterew),  in 
fright,  on  seeing  water  and  fire  and  other  things  have  been  observed 
by  many  authors,  but  without  connecting  them  as  Freud  has  done 
to  conquered  enuresis.  H.  Ellis  emphasizes  the  fact  that  music 
may  call  forth  a  desire  for  urination  in  children  and  animals,  which 
was  even  known  to  Shakespeare,  for  he  has  Shylock  say :  "  And 
others,  when  the  bagpipe  sings  i'  the  nose  cannot  contain  their 
wine  " :  In  regard  to  our  standpoint,  we  shall  have  to  indicate  that 
which  has  been  said  in  the  corresponding  place  and  once  more 
emphasize  that  enuresis,  just  like  every  other  infantile  defect,  repre- 
sents the  functional  side  of  organ  inferiority.  A  fundamentally 
inferior  psychomotor  superstructure  is  placed  over  the  organ  which 
responds  deficiently  to  its  surroundings,  a  superstructure  which, 
with  every  psychical  overexertion  even  as  in  playing  or  learning,  may 
fail,  and  which  will  only  suffice  as  a  cultural  control  of  the  organ 
for  a  time,  if  a  lasting  interest,  an  inner  attention,  watches  over 
the  ordinarily  wanton  activity  of  the  organ.  Release  from  the 


AND   ITS    PSYCHICAL   COMPENSATION  73 

childish  defect  may  be  obtained  through  compensation  in  the  related 
psychomotor  superstructure  and  its  channels  which  may  lead  to 
considerable  strengthening  of  the  psyche  as  a  whole,  but  may  also 
lead  to  all  sorts  of  disturbances,  which  are  present  in  the  nature  of 
the  compensation.  The  psyche,  however,  always  carries  the  traces 
of  the  enuretic  constitution  in  itself  and  in  cases,  too,  where  the 
constitution  is  not  revealed  in  childish  faults,  but  only  in  the  other 
tokens  of  organ  inferiority.  To  the  exaggerated  increased  exten- 
tion  of  the  reflex  channels,  the  jerking  of  the  feet,  inability  to  urinate 
in  the  presence  of  others,  dysuria,  retention  of  the  urine,  involuntary 
evacuation  of  the  bowels,  in  children  is  due,  phenomena  which 
we  find  again  in  hysteria,  in  so  far  as  it  owes  its  origin  to  in- 
feriority of  the  urinary  organs,  while  at'  times  astasia  and  abasia 
in  hysterical  cases  reveal  the  motor  weakness  of  the  segment,  which 
is  fundamentally  connected  with  the  function  of  the  bladder.  The 
enuresis  of  idiots  shows  us  the  entire  incapability  of  compensation 
of  their  inferior  central  nervous  system. 

The  one-sided  over-compensation  in  the  whole  central  reflex 
mechanism,  which  derives  from  the  impulsion  of  compensation  in 
consequence  of  manifold  organ  inferiority,  may  be  at  the  bottom 
of  the  connection  between  enuresis  and  epilepsy.  The  great  need  of 
sleep,  the  particular  soundness  of  the  enuretic's  sleep,  only  corre- 
spond to  the  increased  consumption  of  psychic  strength,  while  the 
normal  work  of  school  or  of  life  may  often  make  itself  felt  as  over- 
pressure. Pavor  nocturnus  in  childhood,  which  very  frequently  oc- 
curs in  enuretic  constitutions,  arises  from  the  over  great  necessity 
for  tenderness  in  such  children  which  finds  its  outlet  at  night  by  sleep 
and  in  the  dark  by  fright  and  screaming.  The  fearfulness  which 
burdens  almost  every  enuretic  in  childhood  is  a  universal  expression 
of  his  helplessness  in  regard  to  the  inferior  organ  and  often  burdens 
even  grown  people.  In  later  life,  in  addition  to  the  usual  character- 
istics, fear  of  water  and  fire,  fear  of  the  night,  is  frequently  added. 
At  times  the  neurotic  is  able  to  conquer  the  terror  in  every  form  and 
to  achieve  the  contrast,  extreme  bravery  and  courage.  Many  of 
the  things  which  we  are  here  writing  down  in  dry  form,  Jean  Paul 
has  interestingly  revealed  in  "  Schmelzle's  Journey,"  the  hero  of 
which,  as  can  readily  be  seen,  shows  a  compulsion  neurosis  on  the 
basis  of  inferiority  of  the  urinary  organs.  Walking  in  the  sleep, 
which  like  talking,  involuntary  micturition  and  evacuation  of  the 
bowels  in  the  sleep,  represents  a  wanton,  pleasurable  organic  activity, 
we  shall  often  find  in  enuretics  corresponding  to  the  frequent  seg- 
mental  inferiority.  The  dream  of  the  enuretic,  connected  during 


74  STUDY  OF  ORGAN  INFERIORITY 

childhood  with  bed- wetting,  very  often  contains  the  act  of  urination, 
and  later,  after  the  time  of  enuresis,  the  idea  of  swimming,  bathing, 
boating,  and  definitely  permits  the  diagnosis  of  conquered  enuresis 
and  appears  particularly  in  childhood  as  primitive  wish- fulfillment 
after  unrestrained  organic  activity  (Freud).  Although  some  retain 
their  fear  of  water  all  their  lives,  others  nevertheless  attain  remark- 
able proficiency  in  swimming  and  boating  sports. 

It  is,  before  all,  the  simultaneous  inferiority  of  the  sexual  organs 
and  the  lasting  interest  in  emptying  the  bladder  which  in  addition  to 
enuresis  almost  regularly  permit  a  second  childish  fault  to  arise, 
namely  early  masturbation,  auto-erotic  touching  of  the  genitals. 
With  this,  new  opportunities  are  given  for  going  astray  in  the 
psychical  development.  The  early  awakened  auto-eroticism  makes 
the  child  more  unfitted  for  bringing  up,  the  prevention  of  bad  un- 
civilized impulses  becomes  difficult  from  the  outside  for  the  same 
reason,  the  child  does  not  adapt  itself  to  cultural  life  and  becomes 
evil  and  unamenable.  At  the  same  time  there  arise  in  him  further 
supports  for  his  cowardice,  shyness  and  anxiety  and  he  seeks  for 
comfort  and  protection  from  the  understanding  which  he  has  of  the 
sin,  in  "  childish "  superstitions  and  religious  fantasies  with  un- 
fortunate results.  In  the  psychoanalysis  of  neurotic  persons  we 
find  both  in  the  ideological  sexual  superstructure.  Physiologically 
viewed,  it  is  compensation  of  the  sexual  organs  in  the  psychomotor 
field,  strengthening  and  check.  How  often  these  happenings  become 
the  foundations  of  psychoneuroses,  as  soon  as  compensatory  inter- 
ruptions and  reciprocal  effects  of  two  inferior  psychomotor  fields 
occur,  Freud  has  irrefutably  shown  in  his  psychoanalytic  material. 
In  my  list  of  illustrative  cases,  also,  there  are  a  number  of  proofs 
which  rest  on  firm  ground  by  reason  of  their  certain  relation  to 
organ  inferiority  and  its  consequences. 

The  accentuated  auto-erotic  trait  which  the  enuretic  shows  and 
the  heightened  interest  in  his  own  sexual  phenomena  makes  it  seem 
comprehensible  that  in  case  there  is  no  other  adjustment,  above  all, 
the  similar  sexual  organ  in  other  persons  attracts  him.  In  a  few 
cases  I  could  determine  this  connection  so  that  homosexuality  and 
exhibitionism  as  phenomena  in  people  with  inferior  sexual  organs, 
often  in  connection  with  the  enuretic  constitution,  becomes  com- 
prehensible. 

I  must  still  emphasize  in  closing  that  the  great  frequency  of 
enuresis  in  the  juvenile  and  habitual  criminal  is  not  difficult  to 
understand.  Both,  function  of  the  bladder  as  well  as  impulses,  are 
at  times  without  compensatory  limit  in  extended  inferiority  of  the 


AND   ITS    PSYCHICAL    COMPENSATION  75 

central  nervous  system,  and  follow  their  course  without  any  atten- 
tion to  cultural  requirements. 

The  signs  of  more  intense  conscious  effort  which  leads  to  the 
compensation  of  the  central  nervous  system,  we  will  miss  completely 
only  in  idiots,  and  partly  in  juvenile  delinquents.  They  appear  in  a 
distinct,  though  abnormal  form  in  neuresthenia,  hypochondria, 
hysteria,  epilepsy,  paranoia,  compulsion,  and  anxiety  neuroses. 
Under  favorable  conditions,  however,  they  may  fall  to  the  lot  of 
another  category  of  people,  strikingly  functionally  capable  brains, 
highly  gifted  and  genius-like  natures,  in  the  consideration  of  which 
we  must  recognize  that  the  psychic  activity  has  given  occasion  for 
restraining  enuresis  together  with  powerful  training  of  the  psycho- 
motor  sphere  to  psychical  and  spiritual  superiority.  Very  often  in 
not  wholly  successful  over-compensation,  we  find  border-line  and 
mixed  cases. 

I  now  briefly  present  the  material  to  which  I  owe  my  report  on 
the  inferiority  of  the  urinary  organs ;  the  choice  was  made  according 
to  the  occurrence  of  the  childish  defect,  enuresis,  in  the  family. 

i.  Siegfried  H.*  34  years  old,  a  merchant,  complains  of  tempor- 
orily  occurring  states  of  excitement,  pressure  in  the  region  of  the 
heart,  feelings  of  anxiety  and  impotence.  Since  his  childhood  he 
has  suffered  from  constipation  and  has  several  times  had  violent 
attacks  of  abdominal  colic.  In  the  course  of  a  severe  posterior 
urethritis  there  was  for  a  few  days  retention  of  urine.  Thyroid 
gland  considerably  enlarged.  General  condition  as  well  as  analysis 
of  urine  normal.  Tendency  to  exhibitionism.  The  father  died  of 
nephritis,  three  sisters  died  in  confinement.  The  patient  says  that 
he  suffered  from  enuresis  until  his  9th  year. 

2.  Oskar  C.,  23  years  old,  a  student,  complains  of  inability  to 
learn,  pressure  in  the  head  and  nervous  irritability.  Lately  there 
have  been  spontaneously  occurring  pains  in  the  right  testicle. 
Normal  condition,  except  for  thickening  of  the  head  of  the  right 
epididymis.  There  are  two  little  knot-like  thickenings  along  the 
spermatic  cord,  which  raise  a  suspicion  of  tuberculosis.  Two 
analogous  cases,  in  which  the  thickening  had  gone  away  led  us  to 
assume  coitus  protractus  as  a  cause,  while  one  of  the  cases  had  for 
a  time  ejaculated  bloody  semen  [rupture  of  the  vessel  ?].  In  the 
case  under  consideration  protracted  coitus  was  admitted.  Otherwise 
ejaculatio  precox.  The  patient  says  that  he  only  wet  the  bed  a  few 
times  when  he  was  9  years  old.  An  older  brother  suffered  till  he 

*  The  names  are  greatly  changed  and  the  bearers  of  the  same  are  fairly 
unrecognizable. 


76  STUDY  OF  ORGAN  INFERIORITY 

was  16  from  enuresis.  The  analysis  of  the  urine  of  the  father, 
who  is  suffering  from  a  mild  form  of  epilepsy,  shows  for  the  time 
being,  albumin,  hyaline  and  granular  cylinders.  The  paternal  grand- 
father and  grandmother  died  of  cerebral  apoplexy  (contracted  kid- 
ney?), one  of  their  daughters  died  of  uremia.  A  second  brother 
of  the  patient  suffered  from  acute  hallucinatory  paranoia  and  showed 
adhesion  of  the  prepuce  to  the  glans. 

3.  Ignaz  W.}  52  years  old,  an  official,  has  been  complaining  for 
a  year  of  vague  pains  in  his  back  and  in  the  region  of  the  kidneys. 
Condition  of  the  urine:  specific  gravity  1007,  slight  traces  of  albumin, 
permanently  increased  quantity,  polyuria,  tension  of  pulse  raised 
above  normal,  second  aortic  sound  accentuated.    The  heart  was 
hypertrophic.     Enuresis  denied.     One  brother  of  the  patient  and 
one  child  have  suffered  from  it.     His  mother  died  at  26  during 
parturition. 

4.  Dolly  A.,  7  years  old,  a  timid,  delicate,  pale  child  who  has 
suffered  from  enuresis  since  her  birth.     Her  mother  was  also  an 
enuretic,  and  her  maternal  grandmother  died  of  uremia. 

5.  Elisabeth  D.,  3  years  old,  nocturnal  and  diurnal  enuresis.     A 
timid  child  who  is  afraid  to  stay  alone  in  the  room,  does  not  go  out 
without  having  some  one  lead  her  by  the  hand,  and  who  shows 
other  great  needs  for  tenderness,  and  desire  for  support.     Pavor 
nocturnus.     She  talks  of  "  making  water  "  almost  all  day  long.     In 
the  father's  family  there  is  enuresis,  the  material  grandmother  is 
suffering  from  contracted  kidney.     When  the  patient  and  her  sister 
fell  ill  of  scarlet  fever,  the  sister  who  was  not  an  enuretic,  showed 
hematuria.     (Spieler  has  published  similar  cases  without  establish- 
ing our  relation  to  enuresis.) 

6.  Friedrich  V .,  42  years  old,  a  merchant,  was  a  bed-wetter,  as 
were  several  of  his  brothers  and  sisters.    At  that  time  showed 
temporary  albuminuria  to  a  slight  degree  and  slight  cardiac  hyper- 
trophy.    On  the  occasion  of  syphilis,  violent  intolerance  of  iodine 
appears.     Chronic  excess  of  phosphates  in  the  urine  of  the  mother 
and  one  sister,  which  I  have  frequently  found  to  be  the  case  in 
enuretic  families. 

7.  Alexander  S,,  28  years  old.     Abulia.     In  response  to  ques- 
tions he  says  that  the  libido  sexualis  is  lacking.     Erection  inade- 
quate.    Ejaculatio  precox.     On  the  left  side  severe  varicocele,  on 
the  right  hydrocele.     The  patient  was  very  fond  of  rowing  and 
swimming.     Frequent   swimming   dreams.      Only   a  year   ago   he 
dreamed  that  he  was  attending  to  the  calls  of  nature  and  urinated 
in  his  bed  at  the  same  time.     Enuresis  up  to  his  tenth  year.     His 
father  died  of  a  renal  affection. 


AND    ITS    PSYCHICAL    COMPENSATION  77 

8.  Albert  K.,  45  years  old,  railroad  official.     Had  had  painful 
retention  of  the  urine  for  twelve  hours.     Went  through  the  same 
thing  20  years  ago.     Analysis  negative.     The  catheter  passed  the 
sphincter    without    finding    any    opposition.      Ejaculatio    precox. 
Enuresis  up  to  his  seventh  year.     Says  he  has  had  no  swimming 
dreams,  but  he  was  a  swimming  teacher  in  the  army.     Seven  of  his 
nine  brothers  and  sisters  died  prematurely.     He  thinks  that  the  re- 
tention may  have  arisen  through  delay  in  urinating.     Normal  be- 
havior after  the  next  day. 

9.  Eugen  M.,  26  years  old,  a  bookkeeper,  complains  of  pressure 
in  the  head  and  weakness.     Phosphaturia.     Of  his  23  brothers  and 
sisters   17  died  of  unknown  diseases,  one  with  the  symptom  of 
dropsy.     Enuresis  up  to  his  twelfth  year.     Eagerly  carries  on  row- 
ing sports. 

10.  Julius  S.j  39  years  old,  a  writer,  is  suffering  from  nervous 
gastric  troubles.     His  mother  died  at  a  ripe  old  age  showing  uremic 
phenomena.     One  brother  has  chronic  nephritis,  a  second  neuras- 
thenic complaints  and  excess  of  phosphates  in  urine.     The  patient 
himself  went  through  a  severe  gonorrhea  and  also  shows  excess  of 
phosphates  in  urine.     Enuresis  during  childhood,  hypospadia  and 
para-urethral  opening. 

11.  Sophie  B.   (already  cited),  went  through  parturition  three 
times.     Pyelitis  during  the  first  pregnancy  with  fever  phenomena 
and  pain,  likewise  during  the  second  and  third.     Normal  condition 
of  urine  directly  after  birth.     Four  months  after  the  last  delivery 
there  were  pains  in  the  region  of  the  right  kidney.     Shortly  after 
this,  chill  and  connected  with  this  intermittent  fever,  for  eight  days. 
Afterwards  lytic  fall  to  sub-normal  temperature,  and  convalescence. 
There  have  been  no  further  phenomena  for  almost  a  year.     The 
analysis  of  the  urine  showed,  at  the  time  of  the  fever,  pus  concretions, 
red  and  white  blood  corpuscles,  hyaline  and  granular  cylinders. 
We  must  consider  the  last  attack  as  the  last  relapse  of  a  pregnancy 
pyelitis  [without  pregnancy?].     At  the  beginning  of  the  sickness  I 
declared  that  the  patient  must  come  from  an  enuretic  family.     After 
denying  at  first  the  patient  admitted  the  following :  namely  that  she 
had  suffered  up  to  twelve  years  of  age  from  bed-wetting,  as  had 
several  of  her  brothers  and  sisters  too.     The  father  died  of  car- 
cinoma of  the  bladder,  one  sister  is  an  idiot,  one  died  in  status  epi- 
lepticus.     The  patient  herself  had  always  been  very  timid.     Two  of 
her   children  showed  enuresis  up  to  the  third  year,   later  pavor 
nocturnus. 

12.  Fritz  C.,  a  merchant,  26  years  old,  fell  ill  three  years  ago 


78  STUDY   OF   ORGAN    INFERIORITY 

with  pains  in  the  hypochondrium  on  both  sides,  which  radiated  out 
toward  the  bladder.  At  the  same  time  a  moderate  fever  is  supposed 
to  have  set  in.  Analysis  of  the  urine  then  showed :  Specific  gravity 
1020,  acid,  normal  quantity,  turbid.  Albumin  0.08  per  cent.,  and  in 
the  sediment  there  were  contained  and  extracted  red  blood  corpuscles, 
hyaline,  finely  and  coarsely  granular  casts,  isolated  epithelial  and 
red  blood  corpuscle  casts,  and  a  few  white  blood  corpuscles.  This 
state  has  continued  with  slight  improvement  up  to  the  present.  The 
pains  also  occur  still,  although  not  very  often.  Differential  diagnosis 
took  into  consideration  nephrolithiasis,  tuberculosis,  neoplasm  and 
nephralgie  hematurique,  among  which  the  latter  diagnosis  seems 
most  probable.  When  one  day  the  patient  showed  me  a  burn  on 
his  finger,  which  he  had  got  at  night  when  he  got  out  of  bed  walking 
in  his  sleep  as  he  had  already  done  a  number  of  times  and  lit  a 
candle  in  his  sleep,  I  advanced  the  suggestion  that  he  had  been  an 
enuretic,  which  the  patient  admitted  at  once.  On  further  observa- 
tion the  patient  showed  himself  to  be  homosexual;  at  times  he 
suffered  from  retention  of  the  urine  for  long  periods  of  time  which 
was  always  connected  with  a  fright.  The  catheter  easily  passed 
the  sphincter.  His  brothers  and  sisters  had  also  suffered  from 
enuresis,  and  a  grandmother  had  died  of  uremia.  The  patient  at  the 
same  time  since  his  earliest  childhood  had  suffered  from  constipa- 
tion, and  had  always  been  accustomed  to  use  the  syringe  every  day. 
(Second  component  of  homo-sexuality.) 

13.  Dr.  L.  Z.,  lawyer,  32  years  old,  neurasthenic.     Fell  ill  eight 
years  ago  of  inflammation  of  the  choroid  and  retina  on  a  hereditary 
syphilitic  basis.     In  the  right  eye  there  is  a  lamellar  cataract  (in- 
feriority of  the  eye  of  an  openly  embryonic  nature).     In  the  urine 
there  is  regularly  nucleo-albumin,  at  times  hyaline  and  granulated 
casts  as  well  as  white  blood  corpuscles.     Complains  of  sexual  weak- 
ness, which  improved  after  the  removal  of  an  exaggerated  phimosis. 
Ejaculatio  precox.     Enuresis  until  his  fourteenth  year,  early  mastur- 
bation,  inclination   to   exhibitionism.      The    father   suffered    from 
paresis,  the  mother  died  of  nephritis  in  her  fiftieth  year.     One  of  his 
brothers  showed  compulsive  ideas  after  an  attack  of  scarlet  fever  at 
the  age  of  twenty-six.     The  patient  is  justly  considered  as  a  strik- 
ingly capable,  highly  gifted  individual. 

14.  Hugo  R.,  ii  years  old,  a  delicate  pale  boy,  suffers,  as  do  all 
his  brothers,  from  enuresis.     According  to  his  relatives  he  is  shy, 
timid,  absent-minded  and  does  not  get  on  very  well  in  school.     His 
mother  died  in  her  thirty-eighth  year  of  tabes. 

15.  Fritz  Sch.,  17  years  old,  shopkeeper's  apprentice,  had  two 


AND    ITS    PSYCHICAL   COMPENSATION  79 

attacks  of  unconsciousness  in  the  course  of  a  month,  which  are  sup- 
posed to  have  been  connected  with  anxiety  on  account  of  the  sick- 
ness of  his  mother.  Weakness  after  the  attacks,  stammering, 
amnesia,  no  biting  of  the  tongue.  The  physician  who  was  called 
came  after  the  attack  which  only  lasted  five  minutes  and  which  was 
without  convulsions.  Physical  condition  normal.  He  is  said  to 
have  always  been  an  unmanageable  child ;  admits  early  masturbation 
and  enuresis  up  to  his  tenth  year.  One  of  his  brothers  also  had 
enuresis,  another  a  neurasthenic  affection  since  puberty,  a  third  suf- 
fered for  a  long  time  from  gonorrheal  arthritis  in  the  knee  and 
ankle  joints  and  has  a  congenital  constriction  of  the  anterior  urethra. 
His  mother  had  an  ovarian  cyst  and  had  to  have  an  operation. 

1 6.  Sophie  K.,   29  years   old,   accountant,   has   suffered   since 
puberty  from  dysmenorrhea.     Half  a  year  ago  violent  pains  in  the 
lumbar  and  sacral  regions  began.      The  examination  per  rectum 
showed  an  intramuscular  myoma  as  big  as  a  fist.     Enuresis  up  to 
her  ninth  year.     Her  mother  died  during  a  delivery. 

17.  Rosa  E.,  32  years  old,  complains  of  pains  which  extend  from 
the  sacral  region  on  both  sides  over  the  back  surface  of  the  thigh 
to  the  popliteal  space.     Strong  sensibility  to  pressure  of  the  sciatic. 
State  of  abdomen  normal.     She  went  through  two  uncommonly 
protracted  births.     Both  times  hydramnion  and  retarded  first  stage 
of  labor.     Slight  rachitic  constriction  of  pelvis.     Frigidity.     Strik- 
ingly short,  plump  legs  with  very  slight  traces  of  rachitis.     Con- 
trasting with  this  a  slender  upper  part  of  the  trunk.     Enuresis  up 
to  14  years.     Urine  and  later  swimming  dreams.     Was  never  timid 
as  a  child,  liked  to  play  with  fire,  and  occasionally  "accidentally" 
(part   played   by   chance!)    burned   up   household   utensils.     Her 
mother  died  at  27  from  a  hemorrhage  during  parturition.     One  sister 
was  operated  on  for  myoma.     She  had  never  suffered  from  enuresis, 
but  was  a  precocious  child  and  suffered  from  a  washing  compulsion 
neurosis.     A  younger  brother  suffered  from  mild  enuresis,  which 
was  soon  outgrown,  from  pavor  nocturnus,  and  as  a  child  showed 
a  highly  developed  condition  of  anxiety.     A  medical  examination 
could  probably  have  found  in  the  urine  of  the  now  22-year-old  man 
nucleo-albumin,  a  condition  which  like  excess  of  phosphates  is  very 
frequent  in  families  of  enuretics. 

1 8.  Hugo  K.,  30  years  old,  a  merchant,  complains  of  headache, 
conditions  of   excitement  and  sleeplessness.     Querulous  behavior, 
and  on  the  basis  of  a  dream  accuses  a  woman  of  his  acquaintance 
of  criminal  intercourse.     Corrects  himself  very  soon  and  sees  his 
mistake.     Earlier  he  had  often  had  violent  attacks  of  rage.     Striking 


8O  STUDY   OF   ORGAN    INFERIORITY 

antipathy  for  his  father.  Homosexual  inclinations  and  a  morbid 
fear  of  dirt.  Early  masturbation.  Ejaculatio  precox.  The 
catheter  easily  passes  the  sphincter.  Nucleo-albumin  in  the  urine. 
Suffered  from  enuresis  up  to  his  fifteenth  year.  His  father  and 
grandfather  had  hypertrophy  of  prostate. 

19.  Alois  W.,  31  years  old,  engine  fitter.     For  two  years  he  has 
had  posterior  urethritis.     Indications  of  hypospadias,  operation  for 
phimosis,  para-urethral  meatus.     His  father  died  at  48  with  dropsical 
phenomena.     The  mother  has  prolapse  of  the  uterus.     The  older 
brother  was  an  enuretic  up  to  his  sixteenth  year. 

20.  Artur  S.,  28  years  old,  a  merchant.     Three  months  after  a 
severe  attack  of  scarlet  fever  he  still  showed  distinct  traces  of 
albumin.     He  has  the  history  of  a  long  continued  gonorrhea.     Since 
then  ejaculatio  precox.     Intolerance  of  sexual  abstinence,   during 
which  he  is  troubled  by  sleeplessness,  violent  excitement,  conditions 
of  anxiety  and  fear  of  insanity.     He  admits  early  masturbation. 
Enuresis  and  incontinence  of  the  bowels  for  some  time.     He  had 
been  an  extremely  delicate  child,  who  only  began  to  walk  at  the  age 
of  three.     Only  slight  traces  of  rachitis  at  that  time.     His  mother 
died  at  an  operation  for  carcinoma  of  the  uterus.     His  father  has 
suffered  since  his  fortieth  year  from  rarely  occurring  typical  epi- 
leptic attacks  and  an  equivalent  in  the  form  of  aphasia. 

21.  Julius  M.,  a  merchant,  38  years  old,  complains  of  deficient 
sexual  power.     Relaxed  sphincter.     Enuresis  up  to  his  twelfth  year. 
His  mother  died  at  an  early  age. 

22.  Georg  A.,  16  years  old,  commercial  student,  has  had  poste- 
rior urethritis  for  half  a  year.     Enuresis  up  to  his  eighth  year  and 
admits  early  masturbation.     His   father  has   suffered   for  twenty 
years  from  temporarily  occurring  lancinating  pains  in  his  legs,  shows 
lack  of  PSR,  positive  Romberg,  slight  ataxia  and  Argyll  Robertson 
pupil.     No  bladder  disturbance,  no  impotence.     His  mother  has  had 
recently  to  have  an  operation  for  myoma,  and  has  for  two  years 
suffered  from  pains  in  the  lumbar  and  sacral  regions.     (The  parents 
both  show  segmental  inferiority  of  the  lumbar  and  sacral  regions.) 

23.  Dr.  M.  L.,  an  author,  41  years  old,  has  for  years  suffered 
from  frequently  recurring  severe  sciatica.     Sexual  precocity  and 
enuresis  in  the  family  is  admitted.     Syphilophobia.     Inability  to 
urinate  in  the  presence  of  others  and  dysuric  difficulties  without 
analysis. 

24.  Josef  S.,  merchant,  42  years  old,  complains  of  a  state  of 
anxiety,  chronic  constipation,  depression  and  eructation.     He  says 
that  in  himself  as  well  as  in  his  brothers  there  was  greatly  delayed 


AND   ITS    PSYCHICAL    COMPENSATION  8l 

ejaculation.  Chronic  posterior  urethritis  with  complications  oc- 
curring repeatedly.  Relaxed  sphincter.  Between  his  eighth  and 
ninth  year  he  had  a  painless  paralysis  of  both  legs  and  was  confined 
to  his  bed  for  more  than  half  a  year  (hysterical  astasia-abasia  or  else 
cured  poliomyelitis?).  His  gait,  reflexes,  motor  power  and  develop- 
ment of  the  legs  since  that  time  have  been  excellent.  On  the  other 
hand,  in  the  lumbar  portion  of  the  spine  there  is  a  lordotic  de- 
formity. The  patient  suffers  with  anxiety,  hypochondria,  inclined 
to  all  sorts  of  complaints  about  his  heart,  lungs  and  digestive  appa- 
ratus, and  has  lived  with  a  healthy  wife  in  childless  wedlock  for  7 
years.  Examination  of  the  semen  is  refused.  He  admits  early 
masturbation  and  enuresis  into  the  fourteenth  year,  and  incon- 
tinence of  the  bowels  for  almost  as  long.  (His  mother  died  of 
diabetes !)  Bed-wetting  just  a  short  time  ago  after  excessive  alco- 
holic indulgence. 

25.  Johann  R.,  39  years  old,  an  official,  complains  of  feelings  of 
anxiety  and  swelling  of  the  knee  joints  occurring  almost  every  two 
weeks,  preceded  by  pollution  and  diarrheal  evacuation  of  the  bowels. 
The  condition  lasts  twelve  days  and  began  probably  in  connection 
with  self-reproaches  for  the  death  of  his  father.     Ejaculatio  precox 
since  then.     Excessive  masturbation  even  in  early  childhood,  later 
increased  pollutions.     Enuresis  and  incontinence  of  the  bowels  up  to 
the  tenth  year.     At  present  there  is  morbid  sleepiness  and  unusually 
heavy  sleep.     (Inferiority  of  the  cerebrum.)     Complains  of  con- 
tinual violent  pains  in  the  lumbar  portion  of  the  spine  and  in  the 
sacrum.     The  lower  extremities  are  remarkably  short  in  comparison 
to  the  trunk.     The  case  was  under  my  observation  for  some  time. 
It  had  to  do  with  intermittent  dropsy  of  the  knee  joints.     The  swell- 
ing appeared  regularly  with  rare  exceptions  every  fourteen  days 
just  above  the  patella,  soon  attacked  the  knee  joint  and  led  to  intra- 
articular  effusion.     In  four  days  every  trace  of  swelling  has  dis- 
appeared.    It  was  easy  to  invoke  a  suspicion  of  tabes.     Prostate 
normal.     The  patient  is  a  passionate  tourist. 

26.  Maria  C.,  17  years  old,  has  suffered  from  her  earliest  child- 
hood from  enuresis  and  incontinence  of  the  bowels  which  still  ap- 
pear quite  frequently  up  to  the  present,  but  which  can  however  be 
checked  for  a  time  by  psychic  influence.     Has  always  been  an  un- 
manageable child  inclined  to  outbursts  of  fury,  but  is  unimpaired 
in  her  psychic   functional  capability.     Often  has   catarrh   of   the 
bladder.     Defect  in  speech.     In  her  early  childhood  she  learned  to 
speak  very  slowly  and  with  great  difficulty.     At  that  time  she  longed 
to  go  to  the  theatre.     No  palatal  reflex.     Mild  rachitic  scoliosis. 
Constipation,  loss  of  appetite  occurs  frequently.     Has  had  appendi- 


82  STUDY  OF  ORGAN  INFERIORITY 

citis  and  typhoid  fever.  She  is  a  courageous  girl  who  knows  no 
timidity.  First  period  at  the  age  of  15,  since  then  they  have  been 
regular  and  painless.  A  great  deal  of  enuresis  in  the  family. 

27.  Wilhelm  N.,  30  years  old,  bookkeeper.     Has  had  gonorrhea 
for  eight  months.     Excess  of  phosphates  in  the  urine.     Complains 
of  chronic  constipation,  which  he  has  had  since  his  childhood.     His 
father    died    early    of    pulmonary    tuberculosis.     Patient    was    an 
enuretic  up  to  his  seventh  year,  his  younger  brother  suffered  for 
some  time  with  enuresis  and  incontinence  of  the  bowels.     (A  very 
frequent  condition  is  to  have  incontinence  of  the  bowels  at  first, 
then  in  later  life,  constipation.     This  often  occurs  in  the  domestica- 
tion of  dogs.) 

28.  Frits  R.,  27  years  old,  a  merchant,  complains  of  temporary 
impotence  and  regular  ejaculatio  precox.    Adhesion  of  the  inner 
preputial  sac  to  the  glans.     In  regard  to  his  childhood  he  tells  us : 
that  he  was  shy,  was  very  much  afraid  of  being  alone  and  in  dark 
rooms,  long  persistent  biting  of  the  nails  and  tic  of  the  left  shoulder, 
clonic    blepharospasm.     Early    masturbation.     Enuresis    until    his 
seventh   year.     Enuresis   and   ejaculatio  precox  occur   quite   fre- 
quently in  the  father's  family.     In  addition  to  these  the  patient  also 
has  slight  struma  parenchymatosa,  at  times  cramps  in  his  calves 
and  cramps  in  the  toes  and  fingers,  no  Trousseau,  Chvostek's  symp- 
tom positive.     Varicose  veins  in  the  lower  leg.     Constipation  and, 
quite  frequently,  headache.     (Inferiority  of  the  legs?     Long  lower 
extremities.     Is  very  fond  of  touring,  skating  and  skeeing.) 

29.  Dr.  Robert  6\,  lawyer,  32  years  old,  complains  of  psychic  im- 
potence and  ejaculatio  precox.     Shows  a  morbid  fear  of  dirt  and 
suffers  from  headache  and  conditions  of  anxiety.     Enuresis  up  to 
the  twelfth  year,  a  family  trait.     Nevus  pigmentosus  over  the  top 
of  the  bladder. 

30.  Leopold  M.,  23  years  old,  complains  of  anxiety  arising  with- 
out any  cause,  inability  to  work  and  headache.     Ejaculatio  precox 
and  spermatorrhea.     Relaxed  sphincter.     No  gonorrheal  infection 
(just  as  little  in  the  above  cases,  if  it  is  not  mentioned).     Denies 
early  masturbation  and  enuresis,  but  says  that  the  latter  is  a  family 
trait. 

31.  Leo  T.,  an  official,  34  years  old,  complains  of  frequently 
occurring  pains  in  the  region  of  the  left  ankle  joint  (rheumatic  in 
character),  of  irritability,  exhaustion  and  violent  outbreaks  of  pers- 
piration.    Repeated  analysis  of  the  urine  shows  only  an  excess  of 
phosphates.    The  question  in  regard  to  ejaculatio  precox  is  an- 
swered in  the  affirmative.     Likewise  the  one  in  regard  to  enuresis 
in  the  past. 


AND   ITS    PSYCHICAL    COMPENSATION  83 

32.  Martin  R.}  a  merchant,  33  years  old,  complains  of  frequent 
sense  of  pressure  in  the  stomach,  eructation,  loss  of  appetite  and 
heightened  irritability.     The  examination  gives  no  positive  results. 
Sexual  intercourse  very  rarely.     Ejaculatio  precox  at  that  time. 
Frequent  masturbation   (in  causal  relation  to  the  neurosis  of  the 
stomach)    and  pollutions.     Enuresis  up  to  his  eighth  year.     The 
same  childish  defect  was  present  in  all  the  brothers  and  in  the  only 
sister.     The  latter  has  remained  childless  after  ten  years  of  married 
life. 

33.  Max  S.,  26  years  old,  an  author,  complains  of  severe  states 
of  anxiety  and  palpitation  of  the  heart  as  well  as  of  painful  sensa- 
tions in  the  genital  region.     Two  years  ago  he  had  a  severe  ureth- 
ritis.     Objective  condition  negative.     The  patient  says  that  he  suf- 
fers from  frequent  pollutions  and  ejaculatio  precox.     Spasm  of  the 
sphincter  when  the  sound   is  introduced.      After  long  hesitation 
admits  enuresis  until  his  eighth  year.     His  father  died  of  cardiac 
paralysis,   in   his   forty-eighth  year,   while  in  the  best   of   health 
(nephritis?). 

34.  Dr.  Rudolf  S.,  38  years  old,  refers  his  cured  ejaculatio  precox 
back  to  gonorrheal  infection.     Enuresis  admitted.     Urine  games  in 
childhood,  extinguishing  fire,  etc. 

35.  Rudolf  W .,  manufacturer,  26  years  old,  complains  of  ex- 
haustion, dizziness  and  pressure  in  the  head.     Objective  state  nega- 
tive.    The  examination  brought  an  admission  of  sexual  weakness, 
psychic  impotence  alternating  with  ejaculatio  precox.     Overheated 
sexual  phantasy.     Denies  enuresis  for  himself,  but  admits  it  for  his 
brother.     In  the  frequent  pollution  dreams  he  dreams  of  urinating. 

36.  Max  B.,  an  official,  33  years  old ;  swelling  of  the  lymphatic 
gland  as  big  as  a  hen's  egg,  quite  apart  from  these  numerous  small 
swellings  in  the  left  groin.     Syphilis  a  year  previously.     Since  then 
there  has  been  no  ulcer,  no  peripheral  lesion.     Abdominal  organs 
and  vertebral  column  intact.     Catarrh  of  the  apex  of  each  lung, 
state  of  urine  normal.     Neurofibroma  in  the  region  of  the  left 
kidney.     My  question  about  enuresis  was  answered  affirmatively 
as  well  as  the  one  in  regard  to  ejaculatio  precox.     (Inferiority  of 
the  lower  segment,  localization  of  tubercle  bacilli  in  the  inguinal 
gland?)     Extremely  long  legs,  short  trunk.     Often  dreams  of  fire 
and  water. 

37.  Max  Sch.,  official,  38  year  old,  complains  of  conditions  of 
fear,  anxiety,  palpitation  of  the  heart,  temporary  attacks  of  uncon- 
scoiusness.     Frequent  swimming  dreams.     Question  in  regard  to 
enuresis  is  answered  in  the  affirmative. 

38.  Paula  D.,  37  years  old,  a  merchant's  wife,  during  an  attack 


84  STUDY  OF  ORGAN  INFERIORITY 

of  typhoid  had  the  hallucination  that  the  house  was  burning  and  that 
the  children  must  be  saved.  Usually  she  is  a  courageous  woman  but 
always  shows  tremendous  anxiety  as  soon  as  she  hears  the  fire- 
alarm.  Enuresis  in  the  family. 

39.  Sophie  L.,  32  years  old,  office  holder,  has  suffered  since  her 
twelfth  year  from  ideas  of  fear,  agoraphobia,  terrified  screaming  at 
night.     She  often  dreams  of  fire  and  rain  which  soaks  her  through 
and  through.     Enuresis  up  to  her  eleventh  year. 

40.  Alexander  H.,  22  years  old,  has  suffered  since  childhood 
from  headache,  weariness,  dizziness,  stuttering  and  anxiety  and  com- 
pulsive ideas.     One  of  his  compulsive  acts  often  consists  in  lying 
down  on  the  bed  with  dirty  shoes,  "in  spite  of  the  fact"  that  he 
comprehended  that  he  would  soil  the  clean  bed  upon  which  his 
mother  laid  much  stress.    This  compulsive  act  occurred  when  he 
had  conquered  the  enuresis  (around  his  tenth  year)  and  at  a  time 
when  he  was  in  strong  opposition  to  his  mother.     Likes  to  look  into 
the  fire   for  hours   at   a  time.     Swimming   dreams.     Premature 
sexuality. 

41.  Johanna  H.,  44  years  old,  climacteric  difficulties.     Has  for 
some  time  suffered  from  anxiety  and  compulsive  ideas  and  agora- 
phobia.    In  the  course  of  the  analysis  of  a  compulsive  act  the  sus- 
picion of  infantile  enuresis  arose,  which  the  patient  denies  for  her- 
self, but  admits  for  her  brother. 

42.  Dr.  Max  P.,  27  years  old,  complains  of  anxiety  and  excite- 
ment which  always  attacks  him  after  sexual  intercourse.     When  he 
tries  abstinence  it  drives  him  out  of  the  house,  through  the  alleys 
and  streets,  until  he  again  flees  to  prostitutes  (migratory  neurosis?). 
Frequent  pollutions.     Ejaculatio  precox.     Numerous  symptoms  of 
inferiority.     Enuresis  up  to  his  twelfth  year.     He  is  an  uncommonly 
ambitious  and  talented  person.     Indications  of  spina  bifida  sacralis, 
nevus  pigmentosus  in  the  right  groin,  several  hemangiomas  below 
the  region  of  the  right  kidney.     Segmental  inferiority.     The  patient 
tried  to  help  his  troubles  by  strenuous  "  touring."     Also  note  above 
the  instinctive  running  through  the  streets.     The  maternal  line  shows 
a  number  of  psychoses. 

43.  Alexander  E.,  33  years  old,  with  hypochondriacal  attacks 
since  puberty,  complains  of  suddenly  arising  attacks  of  anxiety  and 
fear  of  a  threatening  misfortune.     Forgetfulness,  disinclination  and 
inability  for  work.     Early  masturbation  which  has  continued  until 
recently.    Bacteriuria.    Relaxed  sphincter.    Enuresis  up  to  his  eighth 
year. 

44.  Julius  N.,  brass-founder,  33  years  old:  Attacks  of  suicidal 


AND   ITS   PSYCHICAL    COMPENSATION  85 

ideas,  ideas  of  injury,  inability  to  work  on  account  of  headaches  and 
dizziness,  which  set  in.  Sexual  impotence  for  a  year.  The  patient 
was  precocious  and  suffered  from  enuresis  up  to  his  twelfth  year.  A 
strong  inclination  to  religious  ideas  comes  in  relation  to  sexual 
motives  from  his  childhood.  Homosexual  inclinations. 

45.  Moritz  Sch,,  40  years  old,  a  merchant  complains  of  suddenly 
arising  states  of  anxiety  at  home,  in  business,  in  busy  streets.     At 
the  same  time  a  feeling  of  weakness  in  the  legs  and  pains  in  the 
sacral  region.     Is  afraid  of  an  apoplectic  seizure  and  tabes.     Admits 
temporary  impotence.     Partial  adhesion  of  the  glans  with  the  inner 
preputial  membrane.     Enuresis  up  to  his  twelfth  year.     Occasional 
traces  of  albumin  in  the  urine.     His  father  died  at  50  of  cardiac 
paralysis.     Neuroses  in  several  of  his  brothers  and  sisters.     Eagerly 
pursued  rowing  and  swimming  sports.     His  legs  are  too  short  for 
the  tremendously  developed  body. 

46.  Otto  St.,  13  years  old,  collegian,  had  numerous  attacks  in 
connection  with  pertussis  in  which  he  sprang  about  in  bed,  or  in  the 
room,  panting,  kicking  about,  and  with  his  features  distorted  by  fear, 
pulled  himself  loose  if  any  one  tried  to  hold  him,  until  after  about 
ten  minutes  he  calmed  down.     His  recollection  of  the  attack  was 
not  wholly  wiped  out,  he  knew  that  "something  had  happened  to 
him."     Usually  a  connection  could  be  found  between  these  attacks 
and  unfulfilled  wishes.     He  had  always  been  a  wild  boy,  who  lived 
with  his  stepmother  in  a  state  of  continual  wrangling.     Enuresis  up 
to  the  present  and  at  times  pavor  nocturnus. 

47.  Lenore  B.,  20  years  old,  began  to  "kick  about"  at  the  age 
of  7,  that  is  she  had  attacks  in  which  she  made  motions  of  the  legs 
such  as  children  make  when  they  have  a  full  bladder.     In  addition 
to  this  she  swung  her  arms  and  twisted  her  body.     Finally  she 
hurried  to  the  toilet  and  locked  the  door.     Later  there  were  attacks 
of  unconsciousness,  of  which  there  was  apparently  complete  amnesia. 
Since  these  attacks  also  occurred  in  her  sleep,  and  were  at  times 
connected  with  passing  of  the  urine,  and  since,  moreover,  dilation 
and  loss  of  reaction  of  the  pupils  were  noticed  during  an  attack,  the 
patient  was  usually  regarded  as  an  epileptic  and  treated  accordingly, 
and  at  all  events  without  success,  with  bromids.     It  was  only  by 
means  of  psychoanalysis  that  the  psychic  conditioning  of  the  attacks 
could  be  indicated,  which  showed  a  continuity  with  the  occurrences 
of  the  day,  and  revealed  particularly  a  tendency  hostile  to  the  mother 
and  in  the  mental  impressions  their  translation  uncovered  many 
references  to  the  toilet.     In  her  earliest  mental  development  the 
enuresis  of  her  brothers  and  sisters  played  a  part,  which  she,  in  spite 


86  STUDY  OF  ORGAN  INFERIORITY 

of  a  like  tendency — she  also  had  suffered  shipwreck  sometimes — 
escaped  through  the  rivalry  with  her  brother  and  the  iron  severity 
of  her  mother,  only  that  later  by  reason  of  the  entrance  of  sexual 
precocity  the  fundamental  inferiority  might  be  recognized  in  the 
neurosis.  The  father  shows  inability  to  urinate  in  the  presence  of 
others  and  nucleo-albuminuria ;  the  mother  comes  from  an  enuretic 
family.  The  patient  has  distinct  homosexual  inclinations  and  shows 
a  slight  scoliosis  in  the  lower  section  of  the  thoracic  portion  of 
the  spine. 

48.  Johann  E.,  13  years  old,  became  subject  to  punishment  when 
he  one  night,  in  a  somnambulistic  condition,  took  a  knife  and  attacked 
his  sleeping  father.     Enuresis  up  to  the  present.     As  a  child  he  was 
very  timid  and  was  afraid  of  being  alone,  and  of  the  dark.     Often 
cried  out  in  his  sleep,  often  walked  in  his  sleep  without  remember- 
ing it  after  he  woke  up.     Drowsiness  on  waking,  great  difficulty  in 
arousing  him.     He  was  seduced  to  masturbation  at  the  age  of  6  and 
to  coitus  at  the  age  of  10.     Strongly  religious  temperament.     Often 
ran  away  from  home,  was  very  fond  of  Indian  stories  and  could  not 
adjust  himself  to  the  coercion  of  school. 

49.  Jakob  K.,   1 6  years  old,  an  apprentice,  became  punishable 
for  stealing  from  his  master.     Enuresis  up  to  two  years  ago.     Pre- 
cocious.    Already  had  to  his  account  a  great  number  of  robberies  as 
a  servant,  and  had  bolted  innumerable  times,  to  wander  about  the 
alleys  without  shelter. 

50.  Leopold  W .,  14  years  old,  a  musician,  was  accused  of  the 
theft  of  instruments,  the  money  for  which  he  used  in  a  senseless 
manner.     Enuresis  up  to  the  age  of   10  and  incontinence  of  the 
bowels  for  which  reason  he  was  severely  beaten.     In  his  eleventh 
year  he  was  run  over  by  a  trolley-car  and  since  then  has  often 
suffered  from  suddenly  arising  dizziness  which  usually  attacks  him 
in  the  street.     Since  that  time  also  he  has  had  occasional  attacks  of 
unconsciousness  which  did  not  show  a  psychic  origin.     No  attack 
was  observed  by  a  physician  however.     During  the  trial,  throughout 
which  he  was  at  liberty,  he  was  tempted  to  a  second  theft  and  was 
condemned.     After  he  left  the  prison — during  his  stay  there  he  had 
had  further  attacks — he  soon  appropriated  others'  belongings  again. 
Quite  according  to  the  whole  scheme  of  the  person — lack  of  suffi- 
cient compensation  in  the  inferior  brain,  which  can  be  proved  by 
the  apparently  epileptic  attacks,  by  the  senseless  use  of  the  stolen 
instruments,  by  the  deficient  mental  development  and  the  ease  with 
which  he  can  be  tempted  to  steal — it  was  all  too  easy,  after  the  first 
theft,  to  recognize  in  him  the  future  habitual  thief  into  which  he 
soon  developed. 


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